Communication eases consolidation conflicts

How to make partners out of perceived enemies

In Halifax, Nova Scotia, Canada, a major government initiative to fold five area hospitals and clinics into one system left turmoil in its wake, alienated staff, and made some workplaces more like places of misery than places of healing. But a group of nurses decided to rebuild relationships from the rubble, forming partnership councils that are reinventing departments and changing the focus from management by directive to working by cooperation and consensus.

The immediate results of the mergers two years ago weren’t positive, says Rona Cathcart, partnership council coordinator at the QE2 Health Sciences Center, one of the newly renamed facilities that make up the health care system in Halifax. "The physical aspects of merging were easy, but there were emotional issues that were not addressed," she explains. "The practices were different. There were two different emergency departments [EDs] that had different ways of handling people, different triage systems, different everything."

Staff were moved around and put into facilities that functioned very differently than what they were used to, says Cathcart. "[The government] built a new infirmary and closed the old one. The school of nursing was closed at Victoria General and moved to the university. It got so bad that nursing staff in one ED were literally screaming at each other. People felt very bad, and there was a lot of frustration."

What does a healthy workplace look like?

Finally, the nursing staff and vice president of nursing at the QE2 got together to find a way to address the problems. "While a lot of people wanted the administration to fix’ the situation, the VP wanted us to figure out what the issues were and solve them ourselves." The group decided to draw a picture of what a healthy workplace looked like. "We did some research and found that the United States has about 20 years of information on the issue of partnership councils," says Cathcart. "We were like sponges on the topic."

Much of the best research came from Bonnie Wesorick, RN, MSN, the founder of the Clinical Practice Model Resource Center in Grand Rapids, MI. "She says it is hard to do in a unionized environment, but we managed it," Cathcart adds.

Wesorick says partnership councils are more than talking shops where people focus on problems. They are rather places where "the people who work in a department or unit can come together to develop healthy partnering relationships and have meaningful conversation. [This helps them] create the best place in the world for anyone to receive care and the best place in the world for anyone to work."

Cathcart’s facility established partnership councils in every department with virtually every staff sector involved. "We have it from A to Z, from our labs, to the pharmacies, to the porters," she says. "Physicians, nurses, managers — everyone is involved."

The goal of the councils is to get people to deal with each other directly and address departmental and organizational problems and issues together, rather than complain about situations and relationships. "We look at the institution and organization as a whole, our roles in it, and our fit," she says. The councils have also tried to flatten the hierarchical structure of the hospital. "We want less bossing and more coaching and facilitating."

The partnership council in the radiation oncology unit where Cathcart works includes six people — a tenth of the staff on the floor. "Each of the six people is responsible for 10 other staff," she explains. "I regularly communicate with my 10. They bring issues and problems to me to discuss in our council meetings. We do research, get information, and make decisions through consensus."

Other councils are much larger. In the ED, for instance, there are 200 people on the council.

While managers sit on the councils, they are not seen as a power source over the rest of the members any longer, Cathcart says. "Before, if we wanted to do something, they would say yes or no. Now they act more as coaches, telling us if we are heading in the wrong direction and why."

While some decisions seem to take longer to make because of the councils, Cathcart says the decisions made are more deliberate. "We don’t shoot from the hip so much anymore. They are more thought through than they used to be."

So far, the experiment seems successful. "There is much less conflict now than there was when the mergers first happened," she says. "We have a nurse manager who comes into the councils when they first start to motivate them, and to revive their interest if they seem to hit a plateau."

Cathcart says more issues are freely discussed, and while there is a lot of change happening, she thinks it is positive change. "This stops major grievances from festering."

[For more information, contact:

• Rona Cathcart, Partnership Council Coordinator, QE2 Health Sciences Center, Halifax, Nova Scotia, Canada. Telephone: (902) 473-2700.

• Bonnie Wesorick, RN, MSN, CPM Resource Center, 2048 Lake Michigan Drive N.W., Grand Rapids, MI 49504. Telephone: (616) 791-6399. Web site:]