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What’s Going on
at Your Hospital?
The Perils of Playing Small

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What’s Going on at Your Hospital?

What’s Going on at Your Hospital? dealing with underperformers. We will


give you some tools to manage your
In US hospitals today, one in 20 patients emotions so that you can play big and
receives the wrong medication. Three step in to do what’s difficult more often.
and a half million patients become
infected while being treated in hospital. Why Do We Play Small?
Half get infected because someone
simply didn’t wash their hands. If that At the heart of why people play small is
doesn’t upset you then this statistic the space between their intention and
surely will; 84% of health care personnel their impact. Most health care workers
in these settings have witnessed have an intention to do the right thing
coworkers taking short cuts that could and provide great care, and many do.
be dangerous to patients, yet fewer than Unfortunately, for a large number, their
10% of physicians or nurses directly impact can be something quite different.
confront their colleagues about their Something happens between intention
concerns 1. and impact. That ‘something’ is the
black box (our brain) where we make
Here is an example of incompetence decisions and where a clash is going on
that goes unreported. A group of eight between something we call our small
anesthesiologists agree a peer is self and our big self.
dangerously incompetent, but they don’t
confront him. Instead, they go to great
efforts to schedule surgeries for the
sickest babies at times when he is not
on duty. This problem has persisted for
over five years 2.
Intention Impact
What’s going on?

Do health care personnel not care Small Self & Big Self
about the quality of care you receive?
The small self is that voice of doubt we
Of course they do. Many of the doctors, often hear in our heads when we face
nurses and other health care providers challenging situations. It is a particularly
have gone into their respective strong voice when we feel that we are
professions to give great care and make being evaluated. It might be the voice of
a big difference for you and all who some (past) authority in our life. As
enter the sacred halls of a hospital or Kimberly Dozier said after returning to
health care setting. So what is stopping her job as a CBS correspondent, 25
them from speaking up? In this white operations and 363 days after being
paper, we will examine why people injured in Baghdad; “You know that
make the choice to play small (which we ticker you’ve got running in your head
define as the aversion to take risks, going, ‘Got to please Mom, got to please
have the difficult conversations or the boss, got to—‘ You’ve got all these
believe in oneself); in this case, by not judges out there. [Due to the injury and
What’s Going on at Your Hospital?

past year] I have a freedom I never had


before in terms of saying , ‘You know
what? I don’t care. Because I know
what’s important.’” 3

Left unchecked, however, small self not


only distracts, but paralyses us.

Our small self focuses on what is


negative (usually about ourself) and
causes us to procrastinate or do nothing
at all. It is driven by a scarcity mentality
and can sabotage our best intention to
do the right thing. At the end of the day,
our small self eats away at our In this case, the small self in the
confidence and can incapacitate us. amygdala focuses on the threat that
might harm us, such as the ramifications
Big self, in contrast, is the voice in our of stepping in and dealing with someone
heads that believes in ourselves and is not doing their job properly. ”What if it
not afraid to risk and try new things doesn’t go well? ” “Who am I to tell a
because it loves a challenge. It is that doctor what to do?” “What if they
voice in us that knows we can set a goal accuse me of being incompetent?”
and meet it. It sees ‘what’s possible’ in ”Maybe I didn’t see it the way I think I
most situations and looks for reasons saw it.” “Nobody will want to work with
why something can work as opposed to me after this.” ‘Work is going pretty well
why it cannot. for me – why take the chance of
ostracizing my peers?” This is the voice
Each part vies for control over decision of small self that can absolutely paralyze
making. The part of the brain where the us.
small self resides is called the
amygdala. 4 (The big self, by contrast, is
located in the left pre-frontal lobe of the The Trigger of Our Small Self
neo-cortex). The amygdala is a part of
the older brain that codes for fear and The feeling that we may lose the respect
doubt. When we face situations where of our peers or that we might be
there is a difficult relationship to manage embarrassed is one of the most potent
(someone we know taking a short cut) triggers to our small self in the
or great change in our environment amygdala. For instance, we have found
(rumored cuts in the department), it is in our studies of leaders and individuals
the amygdala—Greek translation that 46% don’t take risks and engage in
meaning almond, which is as it appears difficult conversations (play big)
on dissection—that triggers the small because they are afraid to make a
self to sound the alarm and protect us. mistake or embarrass themselves5.
They are afraid to take a risk because it
may backfire on them. In another study
we found that over 60% of leaders
What’s Going on at Your Hospital?

agreed or strongly agreed that, “an the tools to manage tension in their
important goal for me is to not look bad amygdala (the small self) when they are
as a leader.” 6 on the threshold of making the choice to
play big (to have the difficult
Has this white paper helped you conversation), and a game plan to have
understand why health care the conversation.
professionals—and the rest of us—have
such trouble stepping in and confronting Managing the tension and having the
short cuts and incompetence in the difficult conversation skillfully is not only
workplace? The people who look after one of the significant differentiators of
you, or your loved one , in the next top 10% performance, but leaves people
hospital you visit, desperately want to pleased and proud that they actually did
play big and do the right thing. They it. This pride becomes contagious and
want to challenge others who take short can transform a workplace. This is the
cuts and sabotage great care. They power of playing big. As Martin Luther
want to execute on their best intention. King, Jr. said: “Our lives begin to end
In fact, 71% agreed or strongly agreed the day we become silent about things
that they wished they played big more that matter.”
often7. But clearly they are having
trouble and becoming more and more In the next white paper we will talk about
frustrated every day. how to step in, play big, and have these
tough conversations.

What to do?

Health care personnel are crying out for Dr. JP Pawliw-Fry


help. They want and need the skills to
help them deal with the struggle that 1 American Association of Critical-Care Nurses, Vital Smarts,
Silence Kills White Paper 2005
exists between their intention and their 2 Ibid
3 The New York Times May 24, 2007
impact in order to do the right thing. Of
4 Ledioux, J. The Emotional Brain
course, health care professionals do not 5 What Stops Leaders from Playing Big? IHHP survey data, 2007
require more IQ to execute on their 6 IHHP Study 186a, 2007
7 The Desire to Play Big IHHP survey data, 2007
intention. This is a group of highly
trained and intelligent people who know
exactly what it is they need to do. What
they need help with is:
1. Managing the difficult emotions
that arise as they attempt to do
the right thing that is putting them
at risk; and,
2. A game plan (the skills) to have
the difficult conversation.

In our Advanced Emotional Intelligence


program, The Three Conversations of
Leadership, we teach individuals both

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