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I was really blown away by the study quoted and its implications. Often a sense of a lack of safety is what keep people silent; it makes me wonder if the surge in the recent decade of malpractice suits has created a culture of fear that is keeping people silent; or maybe a system of hierachy regarding decisions being made. I think a dialogue about why the silence would help reveal some of the potential areas where systems could be supported to provide individuals with the safety to speak up.

What is the belief sytem around conflict in your department? My sense is like most enviroments that the frame is a perspective of winner/loser. Maybe developing a frame of we all can win when conflict arises could be an interesting approach to project.

Just some initial thoughts - look forward to digging a bit deeper.


Katia, thanks for your comments - you make some great insights here. Yes, the hierarchy is certainly alive and well, especially between physicians and nurses. The good news is that people are starting to surface the concerns around communication. The Silence Kills article is making its way around the hospital and some are using it as a starting point for a dialogue, but these are mostly pockets. Interestingly, tomorrow a few of us will try to make a case to an OR Manager group on the importance of learning dialogue skills so that the question you surfaced re: belief systems about conflict can be explored. By the way, the 3S would be part of this conversation. I'll let you know how it turns out!


This is great - In the 3/28 forum mailing about the nurses in a hospital system having an individual that they can go to support them as they manage issues and conflict I began to think about your work. Wondering if there is a new role needed to support individuals to find comfort in facing the silence and conflict

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