Saturday, June 23, 2012

Book Review: "The Real Healthcare Reform"

Note: As with all of my book reviews here on Digital Doorway, I received no payment for this review other than a copy of the book from the authors in order to expedite the review process. 
According to Linda Leekley, BS, RN and Stacey Turnure, RN--the authors of "The Real Healthcare Reform: How Embracing Civility Can Beat Back Burnout and Revive Your Healthcare Career"-- incivility "infects" healthcare workplaces in epidemic proportions. Based on that premise, the authors maintain that it is through embracing civility that true healthcare reform will take place.

In this easy-to-read book, Ms. Leekley and Ms. Turnure offer a step-by-step analysis of the impact of incivility as it pertains to healthcare, and a plethora of exercises and questions to assist the earnest healthcare provider in identifying issues pertinent to the epidemic of incivility, and--more importantly--how to take personal responsibility for turning that epidemic around.

Readers will find that the book is written in a conversational style, with the following chapter headings to pique curiosity:
  1. Why Civility Matters
  2. It Starts With You: Developing Self Awareness
  3. Do What You Say and Say What You Mean: Personal and Professional Integrity
  4. Good Fences Make Great Neighbors: Building Professional Relationships
  5. Working in the Salad Bowl: The Importance of Teamwork
  6. Eliminate Gossip and Bullying: The Bully-Free Workplace Pledge
  7. You Can't Always Get What You Want: Conflict Resolution
  8. Taking It To the Extreme: Dealing With Extreme Incivility
  9. Paving the Path To Civility: The Next Step
The authors state: "Sadly, civility has been overlooked and undervalued for far too long among healthcare professionals--and now there is proof that a lack of civility adds to medical errors, poor patient satisfaction, higher employee turnover, stress, burnout, bullying and higher healthcare costs for consumers."

From gossip and slander to intimidation, sabotage, bullying and hate-ism, incivility in all of its nefarious forms infects the healthcare workplace and takes a toll that is physical, psychological, and financial. And while the authors do not directly mention the spiritual toll of incivility, there is no doubt in this reviewer's mind that the spiritual effects of incivility and bullying are potentially devastating for individuals, organizations and society at large.

Offered as a guide for individuals and organizations, this book would be a very useful text for students working towards a degree in a healthcare-related field, and it would behoove managers and administrators to take the authors' thesis quite seriously.

I especially enjoyed the focus that Leekley and Turnure place on individual responsibility for curbing incivility, underscoring the notion that incivility does not only translate as "politeness", but also as self-awareness, respect, the ability to stay present, the desire to change, engaging in dialogue, and strengthening patience, personal grace and strength of character.

The authors very strongly recommend that healthcare workers refrain from developing friendships with colleagues and coworkers, and they illustrate this strongly worded edict with differentiating criteria for professional relationships versus friendships outside of work. While I at first bristled at this suggestion, my reflections on the complications of workplace friendships gave me pause. Reflecting more deeply on this notion, I found my developing personal opinion on this matter reinforced through the authors' explanation of why firm boundaries in professional relationships can be extremely helpful.

While I'm personally not a great fan of stock photographs of nurses and healthcare workers that seem to populate so many books, websites and blogs these days, some readers may find that the photographs and images utilized in the book offer visual relief from the text, as well as clear illustrations of the main points being made.

From getting along with coworkers to conflict resolution and the biology of anger, "The Real Healthcare Reform" and its companion website, "Embracing Civility", deliver concrete and understandable instructions for improving self-awareness and communication, solving conflicts, and actualizing the lessons outlined in the text.

Studied in conjunction with Beth Boynton's "Confident Voices: The Nurses' Guide to Improving Communication and Creating Positive Workplaces", this book may be one of the significant keys to dismantling the culture of incivility that Turnure and Leekley are certain is undermining our current healthcare system.

Civility begins with the individual, and if we individual workers begin to take responsibility for the situation as identified by the authors, perhaps administrators, managers and the powers that be will also adopt "embracing civility" as their rallying cry.

Please don't miss the authors' appearance on RN.FM Radio on Monday, June 25th at 9pm EST, or listen to the archived recording or podcast following the live broadcast.


Anonymous said...

Keith do the authors tell us anything about the root causes of workplace incivility and how they might be addressed? This seems to me to be a very basic question, but one at the same time is the elephant in the room, because it deals with unpleasant questions of hierarchy and power relationships.

In other words, if the take-away from this book is "Be Nice to Each Other," then it's hardly insightful, is it?

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Thanks for your comment.

The authors actually do not directly or fully address the root causes of incivility in the healthcare workplace, as compared to, for example, Beth Boynton's "Confident Voices".

That said, this book addresses incivility as a behavior for which each healthcare worker can and must take individual responsibility for their own actions.

The authors actually don't simply just say "be nice to each other". They offer tools and skills for developing self awareness vis-a-vis relationships in the workplace and how to navigate the culture of incivility.

I agree with you that there are root causes of incivility in healthcare that need to be addressed, and other authors have done this very well. Perhaps these authors felt clearly that they wanted to particularly address how individuals can take action and effect change within the broader context of healthcare rather than address the systemic issues.

So, I will contend that the book is still a useful and insightful tool, although certainly lacking in the areas you mentioned. I encourage you to call into RN.FM Radio on the 25th to speak with the authors, and perhaps they can enlighten all of us vis-a-vis your very appropriate question.

Linda Leekley said...

Thank you, TorontoEmerg and Keith,for your comments! Stacey and I agree that incivility often stems from an abuse of power—and that misguided power can be real or perceived. The classic example is the physician who is uncivil and disrespectful to nurses. But incivility travels in all directions…from nurse to nurse, from secretary to nurse, from nurse to nursing assistant and so on. (In fact, the original impetus for the book was hearing from so many nursing assistants that they feel disrespected by nurses! It hit me that we were passing on the same behaviors we abhor from physicians.)

Obviously, incivility has many root causes, from workplace hierarchy to gender, generational, cultural and personality clashes. And, yes, those causes deserve serious and detailed discussion. However, in the end, many of those root causes are beyond the control of an individual employee. Our goal with The Real Healthcare Reform was to focus on what each of us can control—our own emotions and behaviors. By offering tips and strategies for becoming more self-aware and for dealing with incivility, we hope to empower healthcare employees (both clinical and non-clinical) to *become the change they want to see.*

In the final chapter of the book, we give strategies for addressing the specific root causes of incivility in the reader’s workplace—and illustrate how one person can strive to change the system. However, ultimately, Stacey and I set out to promote a grassroots-style embrace of civility by individual healthcare employees. We believe that employees who are being beaten down by incivility may benefit more from learning how to move forward toward a less toxic work atmosphere rather than looking backward at how the pollution started in the first place.

TorontoEmerg, we hope you can listen in to our interview with Keith and, if so, would love to hear more of your thoughts!

Thank you!
Linda Leekley