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Fighting the war on dogma


In a message to Congress, Ab­raham Lincoln said, “The dogmas of the quiet past are inadequate to the stormy present.” These words resonate in the current healthcare environment: As health professionals, are we trying to avoid the stormy healthcare environment by clinging to the past?

We need to turn away from the dogmatic approaches of the past, such as those of autocratic “command and control cultures,” which have contributed to today’s problems of medical errors and higher costs. But first, we must understand what dogma is.

How to recognize dogma

Dogma is a system of principles, a prescribed doctrine laid down authoritatively, a settled or established opinion, belief, or principle. One way to recognize dogma is to investigate whether its premise is sound. Do the facts validate it? Does research support or disprove it?

A second way to recognize dogma is to evaluate it in light of the purpose for which it was intended. If your facility has a new checklist or rounding policy, for instance, ask yourself: Are these things serving patients? Or are they just more items on a nurse’s to-do list?

How to fight dogma

Once you recognize dogma, the next step is to overcome it. That means presenting a succinct, effective case for changing the current thinking.

One technique is the “pitch.” A pitch is a concise verbal (and sometimes visual) presentation of an idea. Remember—you may be pitching to a physician, a nurse, a coworker, a patient, or a patient’s family member. To make your pitch as effective as possible, follow the steps below.

Step 1: Assess your timing. Choose the best time to make a pitch. How urgent is your situation? Is your organization preoccupied by a crisis?

Step 2: Choose the right venue. Who needs to hear your information? Where and how can you best reach the people you’re pitching to? Options include one-to-one communication, a meeting, a collaboration, a written article, and a public speaking event.

One-to-one communication can be as simple as an informal conversation with a peer or nurse manager. If your idea will benefit patients or your work group, consider broaching it in a staff meeting. If you choose a meeting as your venue, you might want to talk to another nurse or your manager beforehand; also, pick a meeting where supportive people will be present.

If you decide to collaborate with another person, ask a peer to act as a sounding board so you can test the validity of your idea, or invite her to accompany you when you discuss your idea with your manager. Look at the politics of the situation and plan your strategy. Are there certain alliances you can tap within the group to whom you’ll be speaking?

If your idea involves people outside your department, consider making your pitch in writing. For instance, write down your ideas and submit them to a newsletter, or write an article and submit it to a professional journal.

If you want to go the public speaking route, perhaps you can present your idea at a company-wide meeting—provided it’s the right audience.

Step 3: Pick an approach to support your idea. You can make your pitch using a wide range of approaches. (See Pick the right approach for your pitch by clicking on the PDF icon above.)

Step 4: Use a combination of “I” and “you” statements. “I” statements are a great way to practice assertiveness. They help us show ownership for our part and respect for others. Use the “I” statement checklist developed by Beth Boynton (part of which appears below) to decide whether such a statement would be appropriate in a given situation.

  • I am trying to repair, build, or maintain a relationship.
  • I value and respect the opinion of others.
  • I am willing to compromise or collaborate.

“You” statements appeal to others’ interests. The statement “I don’t like this policy and I don’t think many other nurses will like it, either” might not be received as well as “Using this policy will result in the loss of at least three nurses, costing the department more than $150,000.”

Step 5: Be prepared to negotiate. In making your pitch, be prepared to negotiate to help move toward a solution. Here are some negotiation methods:

  • Build relationships. Relationships are important to the gentle art of persuasion; successful negotiators are skillful relationship builders.
  • Maintain your personal values. Strong personal values ground you during chaotic times.
  • Promote trust. Trust saves time and energy. When you trust someone, you can dispense with credibility assessments every time you meet.
  • Agree, compliment, and find a grain of truth. Agreeing with and complimenting the other side tends to disarm them. For instance, say, “I see you’ve given a lot of thought to this situation.”
  • Use diffusion. With diffusion, you make a statement no one can disagree with. Example: Patient safety is our prime responsibility.

It’s time for nurses to recognize dogma and help eliminate it by effectively pitching our ideas for overcoming it.

Selected references

Boynton B. Confident Voices—The Nurses’ Guide to Improving Communication and Creating Positive Workplaces. CreateSpace; 2009.

Fabre J. Smart Nursing: Nurse Retention and Patient Safety Improvement Strategies. 2nd ed. New York, NY: Springer; 2008.

Tucker AL, Edmonson AC, Spear S. When problem-solving prevents organizational learning. J Org Change Manag. 2002;15(2):145.

June Fabre is a speaker, consultant, and educator on nursing culture and patient safety. She is the author of Smart Nursing: Nurse Retention and Patient Safety Improvement Strategies. Her organization, Smart Healthcare, LLC, has influenced improvements in medical environments that directly affect nurse performance and retention as well as patient safety. You may contact her at info@junefabre.com.

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