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Creating a Culture of Civility
Three years ago, an internal study found that Huntsman Cancer Institute employees experienced significant compassion fatigue. Director of Nursing Services Sue Childress teamed up with HCI executives, providers, and managers to combat burnout by promoting conscientious leadership and a culture of civility.

hree events impacted me in 2015:

First, a study by HCI Nurse Manager Melissa Banner and Clinical Nurse Whitney Houser showed that we had a real problem at HCI with compassion fatigue and burnout. Compassion fatigue is a normal response to what we do in cancer care. We’re listening to sad stories all the time, and you can’t help but internalize them. Very few of us are immune to it.

Second, during our annual leadership retreat, we found that our highest-performing leaders were overwhelmed and burned out. When we broke into small groups to establish specific goals for the coming year, people were unable to focus on the future because of burnout: either too much work, the inability to manage work, or the lack of support from bosses.

The third event was personal. My son, Ben, is an artist, but he has to pay rent. He’s worked everything from flower delivery to piano moving. Two years ago, he moved back from Portland, Oregon, and started as a valet at Huntsman. After his first week, I asked, “How’s it going?” He said, “Mom, this is the most meaningful job I’ve ever had in my whole life.” I thought, “Honey, you’re parking cars.”

But then he told me how the valets get to know the patients. They celebrate good news and sympathize with bad news. The patients tell those valets everything about their experience at the hospital. My son even spent an hour sitting with one of our 19-year-old patients, listening to that young man talk about what it’s like to be dying. Nurses are used to these conversations. But how amazing that my son thinks so highly of his work. He’s had the opportunity to do other things in the last two years, but he keeps saying, “This is a meaningful job.”

These events combined to help me realize four things:

#1 Recognize that all of us are blessed with meaningful work

Whether you’re in direct patient care or not, all of us are no more than one or two employees away from a patient being impacted—sometimes for the rest of their lives. As we looked at how to address compassion fatigue and burnout, Don Milligan and I, with Ben Tanner’s support, created the Compassionate Workplace Committee. Leaders on this committee included Melissa Banner, Alyson Harding, managers, front-line staff, physicians, and our communications department.

We surveyed 1200+ HCI employees, of whom 400 responded. That led to a deep analysis of workload, environmental issues, and employee support initiatives. With executive leadership support, we increased FTE. To address compassion fatigue, we opened wellness classes to front-line staff. We remodeled breakrooms—just putting on a coat of paint made a difference. We initiated Schwartz Rounds—shout out to Patricia Galbraith and Tracey Nixon for their help getting that program off the ground. We established a website with information and resources. We got a grant to establish resiliency retreats. We opened our own Starbucks. We provided chair massages—that was the #1 thing that staff said would make them feel better.

After 18 months, we surveyed staff to see what kind of impact these changes had made. Again, we received around 400 responses, and although the surveys showed we had made progress, it wasn’t as significant as we would have liked. Our efforts were recognized and appreciated, but we realized the work we had already done was the easy part.

#2 Create a culture of civility

A theme of that second round of comments centered on civil communication. We heard about bullying—managers were either allowing these behaviors to occur, ignorant of their occurrence, or even doing the bullying themselves. This made us heartsick. At our 2017 retreat, we presented this information and heard from managers about the challenges of holding employees accountable for their behavior standards related to civil communication.

The executive team decided that one of our leadership goals would be requiring all managers to attend at least two organizational development classes: Crucial Communications and Speed of Trust. Our HR rep, Tonya Jensen, helped us better understand the complexities of counselling staff. We outlined a clear process of how to address incivility (see below). We wanted to create a compassionate workplace that has zero tolerance for incivility.

#3 Define your vision and provide tools, processes, and support

Here’s the outline we developed:

Clearly convey expectations around communication standards.

We already have PROMISE standards in place. Let employees know we’re going to use them and hold them accountable.

Identify the difference between incivility and constructive criticism.

Sometimes this is hard. Most of us can identify with that. It’s not easy to get the gift of feedback. It is a gift, though. It’s important—most people don’t speak up.

Talk to your peers first.

A lot of our employees don’t have the skills to do that, but we want them to try. We have to understand that there may be an imbalance of power and a risk involved responding to a peer—especially if it involves a provider. But we have to encourage staff to speak up if they’re being bullied. This can go through a manager, or anonymously through the Report & Learn (RL) system, which has a very specific behavior section that allows us to identify what’s going on and follow up.

Address uncivil behavior immediately.

This is key. When the process involves doc-to-doc discussions, managers can provide further support. For employees and staff, addressing the behavior immediately and in person allows for both sides of the story to be heard. We try to understand the underlying frustrations and communicate future expectations, documenting the discussion and creating a plan for success.

#4 Be kind and selfless

We’re just starting this journey at Huntsman, and our plan is to continue educating our managers to address conflict resolution, give and receive feedback, and work in effective teams. No matter what, remember one thing: be kind and selfless in all you do. Evidence shows this does more for you than the person you’re being kind to.


Sue Childress

Director of Nursing, Huntsman Cancer Hospital, University of Utah Health

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