All Staff Forum: Dialogue or monologue?

Mike Gix | July 18th, 2014

I’m feeling very cranky today, and it’s not just the hot weather causing me to feel that way. I’m frustrated beyond words that the VCH All Staff Forum today was so tightly programmed that there was no opportunity for attendees (you know, front-line staff) to ask questions of the executive team.

Today’s topic of “Delivering Quality Care Within Budget” was excellent, as was the information provided by the executive team. I can’t tell you how many times I heard the word “dialogue”, and I was taking notes. The problem is that there was no dialogue. It was a monologue, one-way communication, with the token 10-15 minutes of open questions at the end replaced by a directed exercise in which we were encouraged to discuss amongst ourselves and write our ideas for finding cost efficiencies on yellow sticky-notes! If you have questions they said, email them to us or talk to your boss. Ok. Message received.


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Mike Gix

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8 comments on “All Staff Forum: Dialogue or monologue?

  • Jennifer Richmond says:

    Why do big organizations have a passion for renaming programs from a descriptive name to one that no one can remember or understand…..and it’s expensive!
    Bed Management to “Capacity Management Suite (CMS)”??
    CSD, CSR, SSD….now MDRD

  • Mike Gix says:

    Greg, I appreciate your comment. I agree with your point that no one who provides feedback here wants to be perceived as finger pointing, or just critical of management or other team members. That wasn’t the intent of either of my previous posts, nor the intent of your comment regarding care planning within Richmond Community. Management team has provided this blog discussion venue, and the All Staff Forums, and I think these are great ideas to help improve communication within a really (really) big organization. Laura’s point that the All Staff Forums are evolving and a work in progress is well made.
    The vexation expressed in my first post has to do with the fact that a co-worker and I had come to the forum (my first to attend in person) on our day off, paid for parking, the whole bit…, and we expected we would at least be allowed a few minutes to ask a question or two about the”big picture” budget situation as we perceive it will effect the quality of care we provide at “little picture” worksites. That opportunity that had been afforded at previous ASF’s was not present for us, and by the end of the allotted hour I was thinking to myself I might just as well have stayed home or just watched the video.
    I think it is good to try various means of eliciting input from all staff, those who feel comfortable asking questions during an open Q & A, as well as those who don’t. I count myself among the latter, and I will guess my co-worker might as well. We were still prepared to ask the questions, however nervously.
    Greg, you mentioned the importance of ensuring that staff forums do not become mere back-patting sessions, and I agree. We need to hear the “success stories”, ie., when new initiatives and service redesign lead to improved outcomes, and cost efficiencies are found in ways that do not diminish quality of care. We also need to be careful that the yearly drive to find even further and deeper cost savings does not diminish care, or disenfranchise one sector of our clientele while trying to meet the needs of another.
    It is my personal opinion that our health system is currently stressed as much by inadequate provincial funding as by demographics, inflation, and program inefficiencies and waste. The health budget, while rising every year, is purposely increasing at a rate less than 1/2 the rate of the yearly growth in costs. This is kind of a “tough love” approach to force the health authorities to every year find savings through service redesigns, cuts, contracting-out, and so on. It is referred to as “bending-down the cost curve”.
    I don’t discount the need to constantly look for ways to do things more efficiently while providing quality care. My worry is that the drive to alter programs and services to stay within a budget that is intended to not meet the expected growth in costs will eventually compromise patient and client care. At that point our VCH guiding principles, such as “Provide the Best Care” and “People First” become less achievable, and more just words on a screensaver.
    This is somewhat off the original topic, but is what motivated me to attend the ASF, and why I had hoped for some feedback from peers in regard to these concerns. Thanks again to all who have commented on this topic.
    Mike Gix

  • guest says:

    I did not attend the forum. But I read with interest Mike’s initial article and Greg’s post in agreement. What I found interesting in Laura’s response was the decision to adopt an exercise to engage participation to alleviate/circumvent potential discomfort with active, actual staff engagement during the forum. Not surprising this tactic resulted in Mike’s (and probably others’) perception of the event as a largely one-sided communication exercise.

    My experience of these kinds of events where senior management invites staff to share experiences–elsewhere, outside Coastal Health– is the fear (often from management) of an open forum degenerating into complaining, grandstanding, a raucous free-for-all often undermines its purported goal. The desire to avoid conflict often ends up trumping the point of the exercise: to actually hear from people and work toward improved communication.

    The worst case scenario is the forum comes off as an empty PR move by management to appear consultative. And that staff who want and expect face-to-face communication regard future forums of this kind in a more cynical light.

    • Laura Case says:

      I’m so glad this topic is generating discussion! I know Vivian agrees with me when I say that we want to hear from staff, we want to answer your questions and we want to engage in a meaningful exchange of ideas — the question is how.

      We are a large, decentralized and complex 24/7 operation. As individuals, we are diverse; some staff are comfortable asking questions in a large crowd, and some staff have told us that they’re not. In addition, we’re usually in a race against the clock and run out of time before we can answer all questions, which is frustrating for us everyone. Yes, we eventually answer the balance of questions by email and VCH News, but we know it isn’t the same.

      In response to staff feedback, Vivian and I put out a call for invites to meet with staff in smaller groups, where they work. We gladly accept invitations and conduct walkabouts. For example, I will be holding two Open Talk sessions with Home Health staff soon — one on August 20 and another on September 10. Home Health staff can register here:

      As for the All-Staff Forums, they’re still a work in progress. One potential solution we’ve talked about is extending the 1-hour meeting by 30 minutes. What do you think? What other suggestions do you have? Vivian and I are listening, and we encourage staff to answer the July All-Staff Forum survey to provide feedback, but do so before August 16 — that’s when the survey closes.

      • Mike Gix says:

        I like the idea of extending the ASF by 30 minutes. I realize this will present its own logistical problems, possibly impacting attendance. An extra 30 minutes, however, could allow for greater front-line input, whether that be in the form of an open Q & A session, or a brainstorming exercise within small groups, and so on. With an extra 30 minutes we could conceivably have both, though I think any serious group based exercises will need to be allotted more than 15 minutes to do more than scratch the surface of any topic. With an extra 30 minutes there could be time for a more in-depth panel discussion of a chosen topic, not just presentations and power points. Maybe ideas for topics could be solicited for from all staff, not just leadership.
        Thanks for the opportunity to have this discussion, the forums, etcetera.
        Mike Gix

  • Mike Gix says:

    I appreciate your response to my cranky letter, Laura. I’m feeling better, and I apologize if I was harsh in my description of the recent All Staff Forum. I should say that it was great to hear about some of the quality initiatives to prevent falls, c-difficile, and so on. The budget presentation from from Glen Copping was informative. It was also informative to hear you and Vivian recap initiatives in Acute and Community. But my sense of disappointment remains. I believe an opportunity was missed for a real-time discussion of concerns of front-line folks. The agenda was fixed by the executive team and no time was allotted for “our” questions or concerns. Particularly when funding deficiencies are causing cuts or other discomforting changes to our services, immediacy, candour, and sufficient time for some give-and-take conversation are required. Lacking these, trust between the front-line and leadership will suffer.
    Given the size of our organization, I can imagine the logistical hurdles to facilitating ongoing dialogues about a multitude of important issues. I appreciate the forums, the webinars, and the responses to questions in the VCH News. But sending an email question, waiting several weeks for a reply, and having to look for that reply on the VCH News is not the same quality of communication as a live discussion with a large and representative range of our VCH peers. It is not that often that a lot of us gather with the CEO, CFO, COO’s, VCH Board members, Senior Medical Director, and so on – all in the room at the same time. By all means, pick our brains for ideas on how to ensure quality and cost-efficient care. But please also allow us time to pick your brains about our concerns, Thank you.
    Mike Gix

  • Laura Case says:

    Thank you for your feedback. In an effort to provide everyone a voice – and to tap into the great ideas we know staff have – we thought we’d try something different from an open Q & A. In addition to having limited time during the forum, we’ve received feedback that everyone isn’t comfortable asking questions or providing suggestions in an open forum, which is why we changed the format. The exercise enabled all staff to have a say, and we’ll be reading each and every submission. We still welcome everyone’s questions, too, and we do answer them on a regular basis in-between All-Staff Forums. A survey will be distributed soon as well, and we welcome everyone’s feedback. We are learning as we go, and we’ll keep trying to improve the forum experience.

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