Communicating with Care: Strengthening Professionalism and Teamwork

Dr. James K. Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic education podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano:

Hello. Welcome to today's episode of MedEd Thread, an education podcast exploring professionalism in action as it relates to mastering the art of care and communication at work. I'm your host, Dr. Tony Tizzano, director of student and learner health here at Cleveland Clinic in Cleveland, Ohio. Today, I'm delighted to have Mikaela Baucco, nursing professional development specialist with us here today. Mikaela, thank you for joining us.

Mikaela Baucco:

Thank you for having me.

Dr. Tony Tizzano:

Mikaela, to get us started, could you tell us a little bit about yourself, your educational background, what brought you to Cleveland, and your roles within the Cleveland Clinic Health System?

Mikaela Baucco:

Absolutely. I was born and raised around the Cleveland area, so I was lucky to go into healthcare because we have such wonderful opportunity here in Cleveland. But I fell into nursing completely by accident back in high school where I took a program to become an LPN. So I was able to graduate high school as an LPN and work for four years in physical rehab facility while I went and got my RN degree. And then as soon as I got that degree, I was able to enter Cleveland Clinic and work on the specialty care transplant unit, which I did for several years. And then I jumped a little bit to the recovery room. I did a travel nursing stint before it was a cool thing to do. And then I found myself as a kidney transplant coordinator for many years before I moved into my current education role.

Wow,

Dr. Tony Tizzano:

Fabulous. So lots of experience. And I think it's interesting. So you were in a pipeline program that ended up bringing you into nursing. I mean, I think it emphasizes we've done podcasts around these, how important they are.

Mikaela Baucco:

Yeah.

Dr. Tony Tizzano:

So in today's segment, we'll explore how Cleveland Clinic's Office of Nursing Professional Development is enhancing professionalism within its ambulatory nursing teams through innovative programming that seeks to foster care and communication with patients among professionals and teams to provide the foundation for Cleveland Clinic's overarching goals as a high reliability organization. So Mikaela, if you could help frame for our listeners today's topic by giving some context around the scope and goals of your work and this important program and the impetus for it and its target audience.

Mikaela Baucco:

Absolutely. Well, we look to see what are the care gaps or what are the needs, what are the wants in terms of education and professional development. And this class specifically is really meant to support the professional environment and the way we interact together, the teamwork across disciplines, the teamwork within a team on a unit itself, the free exchange of ideas, meaning we aren't discounting people's thoughts based on some level of hierarchy or what their role is. And we have it as a safe environment where you're not going to be looked down on or feel silly or stupid for suggesting or making an idea known to your colleagues. And how we manage conflict and those tensions we may feel with coworkers day to day, those were big asks that we had found through needs assessments we send out to the caregivers and leadership every year. So that was always a big piece of it.

Communication and professionalism, that was always identified as what the caregivers were looking for. We also, on my team, we meet with the leaders, the managers, the directors throughout the year and ask them what they are identifying as needs for their teams. And again, that was a pretty consistent ask. We also reviewed the Press Ganey and patient satisfaction survey results, which identified this need as well.

Dr. Tony Tizzano:

So for our listeners who might not be familiar with Press Ganey, tell us a little bit about that and how that's used.

Mikaela Baucco:

Yeah. So Press Ganey is a survey that is sent out to caregivers and we do those where we provide anonymous, honest feedback about what we feel might be the gaps or opportunities or what's going well within Cleveland Clinic and they analyze those results and then we try to make action plans based off of that. I should say leadership does. And so we are a part of that in nursing education. We can support those action plans.

Dr. Tony Tizzano:

So for us as workers, they're looking at how workers feel. Right. So important feedback. Not all businesses do that. I think that's a really great thing for us to do. You also mentioned hierarchy and that your program strives to flatten hierarchy. I think that's really a key initiative. I think in healthcare there has historically been a lot of hierarchy and I think at Cleveland Clinic perhaps we've upended that by saying patients first. So at the top of that pyramid are patients. So what else do you look at in terms of hierarchy among professionals?

Mikaela Baucco:

Right. I would say that we promote the idea that everybody has a background, they have professional experience in whatever their role may be, whether that was in healthcare or not. You still learn, especially when you're thinking about communication and professionalism, those are not topics specific to healthcare, right? So your professional lived experience and just your life experience in general, every single person here, whether you've gone to school to become an MD, physician, PA, nurse practitioner, RN, LPN, medical assistant, it doesn't matter in that sense. You still have value, you have lived experiences that you can bring very valid ideas to the table. And we are always looking across Cleveland Clinic to become more efficient, to see what are the gaps in care and how can we change those so they're no longer gaps. And anyone can bring those ideas to the table and they should have that opportunity and they should have the respect to be taken seriously and not treated like their ideas are less than because they didn't go to school for something - For 12 years.

That someone else might have, right?

Dr. Tony Tizzano:

Right, right.

Mikaela Baucco:

Exactly.

Dr. Tony Tizzano:

Boy, I just couldn't agree more. I can't imagine having kind of retired and come back, what I would do without my MA.

Mikaela Baucco:

Yes.

Dr. Tony Tizzano:

You know, and without the front desk to kind of screen who needs something and needs it now and to recognize these issues. Every one of our team members are relevant.

Mikaela Baucco:

Absolutely. And,

Dr. Tony Tizzano:

And I think if, if we have that plateau and we're all looked at at the same, people will come forward with ideas and it makes us all better. So when was the Professionalism and Action program launched and what are its essential elements?

Mikaela Baucco:

Yeah, absolutely. So this program, this class, which we have since retitled, we now call it Communicating with Care, we launched it in October of 2024. And to date, we've had over 1400 caregivers attend. And the agenda, we start off by talking about and really breaking down professionalism. And I don't start by telling the students or the caregivers in the class what professionalism is. We really have that as a discussion. What do you think professionalism is? When you are looking as either a caregiver working or a patient coming in, for example, we pose the question of, what are you looking for? What is telling you the people around you or the people caring for you are being professional? And so we have them share their thoughts and ideas about what that is. And then we really break down the appearance piece of that, what the professional appearance standards here at the clinic are, and then we move into what are the behaviors, right?

What are considered disruptive behaviors? What does our code of conduct tell us? And we have those conversations. And then we really move that conversation into professional accountability or this idea that no matter what the culture of your unit is, if you have colleagues who all do something that is perhaps against the rules or something we know we shouldn't do, it's not freedom to say, "Hey, I can do that too because everyone else does." But to really take ownership of your own actions and the way you respond to things, because we just share, you could be 100% correct. Somebody should not be doing that. They shouldn't be treating you a certain way, but you're never gonna control them. You are never going to force somebody else how to act and they're not gonna control you. So the way you respond, you really wanna take ownership of that and respond in a way you feel would be appropriate.

So we have really deep conversations into that.

Dr. Tony Tizzano:

You make an excellent point there. And I think that notion of appearance and how we conduct ourselves as an element of professionalism is a key. And you know, many of the people who come to us out of pipeline programs, for example, may be the first professional, healthcare professional in their family. And that formation of professional identity is not something that just happens - No. With a magic wand.

Mikaela Baucco:

Right.

Dr. Tony Tizzano:

It's developed. And I think your program seems to be doing that.

Mikaela Baucco:

Yeah, absolutely. And honestly, these aren't things people often think about, right? I mean, unless you come to a class where you're specifically having those conversations, you don't really think about this in your day-to-day work. And it's easy when we're caught up and when we're facing these very serious patient situations or high pressure times to forget about these professionalism pieces, right? So we have those conversations, kind of bring it back to people's forefront of their mind and maybe share new perspectives they hadn't thought about. We then move into communication basics. So really looking at what makes effective communication different from ineffective communication. And we say, "What are the real barriers?" Because there are real barriers in healthcare specifically where you think of time, you think of information channeling through many different layers. You know, someone's been transferred 10 times on the phone and that message gets a little skewed and they get confused on that, right?

There's a lot of different real barriers. So then we talk about strategies of how we can combat that, how we can change that. We talk about this idea of pausing. And so when something happens and it elicits some type of emotion, usually a strong emotion in you or you feel frustrated or aggravated, instead of responding right then and there with your gut feeling, just stepping back for a few seconds, you know, maybe count to 10 if that works for you. I know I personally need at least 20, 20 good minutes to really sit on it and process and what do I feel? Why do I feel so strongly right now? What am I assuming? What's a fact, right? So before I respond the way I initially may want to, I'm gonna sit on it because what I've found in my personal life and what we've seen in some of the research and information is that your perception and the way you respond once you've had a little time is different than what your initial response might have been, right?

So we talk about that and then we talk about other strategies for responding in different situations. So asking genuine questions and we kind of parse out what's genuine questions. There is the I messages. So if you do wanna confront somebody about something that's bothering you, really starting in a not accusatory way where you did this and you did that, but really just starting from a place of, "Hey, I feel really bad when this happened, when you said this because of X, Y, and Z." So it's not pointing the finger because when you do that, even if you're right, people are gonna have their defenses up. And then we also talk about starting with heart. So the heart piece of that, because what we've seen is the two core pieces of the hear and the empathy usually go out the window when we do simulations or we challenge people on that or, or ask for feedback.

A lot of times what we see is we jump straight to an apology and then a response, but we really miss the core pieces of hearing and empathizing before we move into those apologies and responses.

Dr. Tony Tizzano:

I've heard it said that there's a reason we have two ears and one mouth. <laugh> And I think that, you know, you mentioned pause the acronym for pause, acknowledge, understand, study, explore. And I think that kind of mindful approach is something that you have to develop. I don't know that it's automatic because when we get feedback, the first thing we do is thinking, how are we going to respond? And we forget to listen. Then the question becomes, do we have time to really reflect on what was said? And probably the more time, as you pointed out, that we can take to reflect a moment before we put our mouths in gear and respond can take us a long way. So, you know, everything becomes a science. I'm always impressed with the persons who've looked through all this, and then of course, responding with heart, which we want to do with our patients.

So after considering all the feedback and deciding on objectives, how was the course developed and what does it look like?

Mikaela Baucco:

Yeah. So when we were developing this course, I conducted a lot of literature searches to do an extensive review of the practices that was already being put forth by Cleveland Clinic. I really wanted to make sure we were staying consistent with what other groups might be out there within Cleveland Clinic that were sharing information related to teamwork, communication, professionalism, which is how I actually stumbled upon the Office of Interprofessional Learning, which you and I both have had experiences with, and they've so wonderful to work with. And they had information, they had PowerPoints and presentations that they share across the clinic related to this. So we collaborated with them and merged our presentations together. And I also looked at the national nursing organizations that we follow and other national organizations as well. So with that combination, we also really thought about adult learning principles. And this set of topics specifically, we felt could be ripe for higher emotions because when you're talking to adults about being professional and the way they communicate, there could be some tension.

We don't want people to walk away feeling like we've offended them or talked down to them. So we knew we really wanted this to be a very interactive course that also really showed the values we're talking about where people's professional lived experiences are meaningful and they can share in that conversation. And we learn new things from them all of the time. So while there is some didactic piece to that class, we really have the opportunity for self-reflection. We have engaging discussions where they really come up with ideas and then share them with the group, case scenarios and even some interactive games.

Dr. Tony Tizzano:

So what do these scenarios look like? I mean, I think putting that kind of into practice is important because it's one thing to talk about, oh yeah, I get it, I get it, I get it. Now I've got to do it.

Mikaela Baucco:

Right.

Dr. Tony Tizzano:

So what do these scenarios look like?

Mikaela Baucco:

Yeah, that's a great thing. You could even look for yourself. We did work on, again, staying consistent with what's already out there. So for example, some of the scenarios we pulled directly from the Center for Excellence in Healthcare Communication here at Cleveland Clinic. They have a Connect Today page and they really own heart and they have many, probably over 10 different, I think clinical and non-clinical scenarios of all different kinds in which we took those snippets. And so we break them into groups during the class. We give them a patient situation and we say, "How would you respond using heart?" And they have a board in which they can really think through it and write down those responses. And it's always very interesting because it takes sometimes 10, 15 minutes for people to come up with a heart response.

Dr. Tony Tizzano:

Sure.

Mikaela Baucco:

But in a real life setting, you know, we expect that you'd be able to come up with these on the dime. So it really takes that practice and I think those case scenarios highlight that for the caregivers to do heart the way it's intended, you have to practice that skillset. So we do examples like that.

Dr. Tony Tizzano:

Yeah. And I love the fact that in many cases you probably switch roles. I know you and I participated in an exercise where I was kind of the role of the headstrong physician, you were having to deal with that, but then we had to flip it around. It was easy for me to be the headstrong physician, but then to turn around and now I was getting a taste of my own medicine - Right. So to speak. And it's very impactful. Yes. It's impactful when you get to turn things around like that. And I think it's fabulous. And, you know, how, when you look at all of the myriad of things that My Learning and so forth at Cleveland Clinic, an organization with 80,000 individuals, how do they get in touch with the enormous number of opportunities to do the kind of learning that you provide? And how do you get in touch with those individuals who would find it most useful?

Mikaela Baucco:

Yeah. You know, that is a really great question. It's honestly a challenge that I see is when there are so many avenues to get information, it can be a bit challenging. And so I like to joke that I'm a professional connector. So I usually say to everybody is, if you're looking for something and you're not able to find it, I would reach out to your education colleague, whoever provides you education. And even if they can't tell you the answer, we typically know who we can reach out to and we'll be able to eventually find that type of offering. I also know Connect Today is a really wonderful place. All of our education teams have a Connect Today. I actually run hours. I put everything on there. I manage the content. And I know our team really keeps a very clear list of professional opportunities and classes that people can take for that professional growth.

And I link out what I know as the other areas for learning and development as well. So I would say if you're really stuck, reach out to - Reach out. Whoever you know in education or ask your manager. They probably know someone in education and we can all connect with each other is a good way if you really can't find what you're looking for.

Dr. Tony Tizzano:

Outstanding. So just knowing you as just a little bit that I do and the way you are so passionate about this, you know, I'm sure you're weighing and measuring the success of these programs as you roll them out. You know, how has it been received and what were some of the outcomes?

Mikaela Baucco:

Yeah. So we were very pleasantly not surprised. We were hopeful, but we were happy to see that we got really good feedback. So on any course that we develop, any offering we do, we always have an evaluation at the end. We ask for honest feedback on. And we have, part of our evaluation is a Likert score of one to seven, one being, you know, we really did not like this class and seven being this was just the greatest thing in the entire world. And I believe we scored 6.7 total from - Wow.

From all of those 1,400 caregivers. And we also got really positive comments on it. And people will come up to us after class and say the same thing. And often what we hear is, "How do I get everybody in this class? Can this be mandatory? Is it part of onboarding? It should be." Which I'm happy to say it is typically part of our standard onboarding. But I think what I've seen as the most interesting and really positive reinforcing piece is the attitude change from when someone walks in that door coming in knowing they're in a communication and professionalism class. Again, you know, you're talking to people who have been nursing or working in, in their roles for 20 years and they come in and they're not happy to be there sometimes. Sure. They may feel frustrated, "I don't need this class. This feels insulting." But once that class ends, I've had so many people that I've noticed walk in maybe feeling a certain way come up to me after class and they're like, "That is not what I expected it to be.

It was such great information. Thank you." And it's beautiful because then they say, "Here's some other ideas or maybe you can expand in this way." And they're engaged in wanting to share more of their thoughts and ideas on it. So that's been a really great level of feedback we weren't expecting as well. I

Dr. Tony Tizzano:

Love that. And I know, knowing you, that you probably set the stage by putting forth psychological safety. So the individuals who are there say, "You know what? I can be honest. I can be transparent." And even when I take courses that I've been asked to do or am going to perhaps even facilitate, I think, "Well, you know, I know this. This is gonna be really good. I think I'll have something to add." I almost always, well, always, I always come away with, "You know what? I didn't know as much as I thought I did. There were some great ideas here and there's things that I can do to be better."

Mikaela Baucco:

Yeah.

Dr. Tony Tizzano:

You just have to be open to this from the get-go. So clearly, ongoing professional development is essential to optimize communication skills and rich caregiver interactions. What lies on the horizon for your program with communicating with care at work as it evolves?

Mikaela Baucco:

Yeah. So we are going to continue with our needs assessment and those continuous process improvements. We are going to collaborate with other nursing education teams to expand this offering and share this offering. There are other teams that are responsible for the development and goals for other groups, and this content is relevant regardless. So the idea is we'll be able to share this with maybe inpatient, peri-op, physician groups, whoever may benefit from it, and they can take it, make it their own in a sense, and provide that to their groups as well. So we'll hope to expand this offering to other groups and then build on it because there are some really crucial pieces that we can do as kind of a next step of growth in this idea. And one of those topics, as you mentioned, would be feedback because the art of receiving and giving feedback is such a crucial life skill that will benefit you so greatly to start practicing or, or really think about.

And so that certainly could be a next step as well.

Dr. Tony Tizzano:

Yeah, I love that. I think that that whole idea of receiving feedback and episodes ago, we had Laura Greenwald talking about how feedback should be looked at as an opportunity for growth. And so often we're wanting to respond to feedback and not thinking about how might I use what I just learned to further myself in whatever endeavor I'm trying. And I think that the idea of this multidisciplinary addition that you speak of is an important step. And I would hope that involves just anyone. I don't know how long you've been with the clinic, but were you here when we had the Patients First initiative where everybody, the entire organization went to these four hour sessions? Were you part of that?

Mikaela Baucco:

No, I was here for portions of Patients First, but I don't know that I went to any of those.

Dr. Tony Tizzano:

Yeah. So Dr. Cosgrove at the time said, "We're going to do this. Every single solitary worker, whether you're in food service or you're the neurosurgeon, are going to participate in this and you were mixed. So sitting next to you could be Dr. Mihaljevich and, and then someone from food service or sterile processing and yourself and me. So it was interesting to listen to these and have these exercises. It helped to flatten the hierarchy. You got to be more comfortable with peers that are outside your everyday sphere of operations. And I think there's a lot to be gained because Cleveland Clinic always talks about it's a team. And medicine is so complicated and it's getting more and more complicated every day that without a team, how do you maintain excellence? Not be good at what you do, but excellent at what you do. And I think with the work that you're doing is an important step in that direction.

Thoughts around that?

Mikaela Baucco:

Yeah, absolutely. So I think that's actually one of the most crucial things I've noticed, not only doing the research for this class, but in my professional and lived experience is I remember back in my clinical days working on the units and we would have real frustrations with different groups, different interdisciplinary teams, and it would be very challenging to provide good care. And looking back, and I'm happy to say we did do this at certain times, but I think if you are finding yourself in conflict with another group where your workflow depends on them doing something, but they're not doing it, I would really take that opportunity to go shadow them and go watch what is their process like, what is their workflow like? Have them come shadow you and then come together. Because once you understand what somebody's actual work looks like, what their expectations are, their responsibilities, their workload, it really changes your perception.

And just like you said, our medical assistants, our outpatient clinical care assistants, all of these groups that are not high on the hierarchy that these people seem to have in their minds, if you throw somebody from a higher level of the hierarchy in those roles, they're gonna struggle because those roles are very meaningful, they require a lot of effort and thought, and there are some real challenges there. So every one of these groups deserves respect. And sometimes we see this conflict from simply not understanding what someone else's workflow is. So when we have that better understanding, we can say, "Oh, well, if I just change this little thing, then that'll make it smoother for you and then you'll be able to get it back to me quicker and things will be better."

Dr. Tony Tizzano:

That's the give and take of transformation. Right. That's more than just resolving a problem. It's transforming it so both parties come together and find a way at the other end that benefits them both. I love it. So Mikaela, are there questions that I maybe skipped over or didn't ask that you think are important for our listeners to know?

Mikaela Baucco:

You know, one of the biggest themes that emerged during these conversations of our communicating with care at work class is really this idea. And I know you mentioned self-reflection and just self-awareness in general. So it's very easy and we see this. It's human nature. I know I do it too. When I'm having these conversations, I'm thinking, "Oh yeah, I know this person and they do this and they do that." But I don't always take that lens and point it back where I'm thinking, "What were my facial expressions? What were my gestures, my body language, my tone of voice? How was I being perceived by that person?" And when you find yourself in tension or in conflict with somebody, to be able to step back, you know, take that pause, right? Step back and think, "Yes, they did these things and made me feel a certain way." But looking at truly, intentionally, looking at it from their perspective, what were the words I said to them?

How did I say it to them? When we think about where that other person is coming from, even if we don't agree with them, we understand it a little better and it really rehumanizes them and it makes coming together for a solution. It changes those conversations to be more productive, is what I would say that I've seen and that I've learned. I would also really challenge assumptions because we tend to bridge gaps as humans. We do that. We bridge gaps - Sure. What we see as the most likely, "He probably did this because of X, Y, and Z." And while you might be correct, you wanna leave space for the idea that you might be wrong. So instead of coming at that conversation in an accusatory way, we are hoping that we can approach things in a more curious way, right? I have this thought, but is that really the case?

Is that really a factor? Is that something I'm making an assumption on? And then I know we already touched on just the idea of nobody can force you to do anything and your response is really your own. Sure. And so you have that opportunity. Someone's screaming at you and they shouldn't, you have that decision, do I walk away or do I match that energy?

Dr. Tony Tizzano:

Outstanding. Well, I can't imagine that you have conflict ever in your professional. So our listeners can't see this, but Mikaela goes through this entire episode and she is smiling while she's talking. But it brings an important point, you know, having a smile, smiling at someone, even that is very disarming and it melts down some of those barriers to begin with. All these little pieces that we all could do if we just did it with a little bit of intention. I wanna thank you very much for joining. It was a wonderfully insightful podcast. To our listeners, if you'd like to suggest an education topic to us or comment on an episode, please email us at education@ccf.org. Thank you very much for joining. We look forward to seeing you on our next podcast. Have a wonderful day.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic education podcast. Be sure to subscribe to hear New episodes via iTunes, Google Play, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.