Bill Klaproth (Host): This is a special AONL podcast, as we speak with session presenters from the AONL 2023 conference. And with me is Dr. Lindell Joseph from the American Organization for Nursing Leadership. She's also the Chair of the Culture of Inquiry Work Group, as we talk about the culture of inquiry, we're going to learn about that and find out about what that is. And we're also going to learn best practices, as well. This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Dr. Joseph, welcome.

Lindell Joseph, PhD, RN, FAAN, FAONL: Thank you.

Host: Thank you for your time today.

Lindell Joseph, PhD, RN, FAAN, FAONL: I'm excited to be here today.

Host: Yeah, we're excited to have you here. This is great. So first off, can you explain to us what is the culture of inquiry?

Lindell Joseph, PhD, RN, FAAN, FAONL: I would just like you to imagine a work environment where you're thriving. Basically you are able to challenge your status quo. You're able to question things. You're able to come up with ideas and you're supported. That's what a culture of inquiry is all about.

Host: That's something we all want.

Lindell Joseph, PhD, RN, FAAN, FAONL: Absolutely.

Host: We all want a work environment where we can thrive in that. So what is the problem? What is keeping us from building these great work environments?

Lindell Joseph, PhD, RN, FAAN, FAONL: One of the challenges that we have is we have multiple levels of leadership. Right. So a Nurse Manager or a staff nurse may be very distant from the C-suite. And they're not able to share their ideas or they're not able to challenge things that are coming down from the top. So, creating a culture or an environment where people are able to be aligned with the C-Suite with different levels of leadership, that's the critical thing. How do we get people connected? How do we get people to be able to feel like they belong and that they can make a difference? And that they have the voice to make that difference.

Host: So the alignment is what we're talking about. Getting everybody on the same page. So, how do we do that?

Lindell Joseph, PhD, RN, FAAN, FAONL: I think the first thing is to realize that it takes strategy. It does not just happen. One of the things we did when we started this work was that we surveyed Nurse Managers within AONL and we asked them are you comfortable in challenging the status quo? And some people said, well, yes, we are. And we asked them, well, what would help you to challenge the status quo? And these people said a forum for sharing ideas. They want access to adequate information and evidence. They want support from leadership. And they want a culture for risk-taking and innovation.

Host: So they probably feel now they don't have the forum or the ability to challenge the status quo, or there's a fear about challenging upper leadership or the way things are done. Is there a fear in that?

Lindell Joseph, PhD, RN, FAAN, FAONL: Not necessarily. I think nurse managers and nurse leaders, sometimes are so busy, that it's just work, work, work, work, work. So we have to think about how do we enable such a culture. What are the forums that we put in place. Do we have a nurse manager council where people can gather and say, I have this new idea, or this is not working out.

How can I do something differently? When we talk about evidence, do we have all units, all leaders have access to evidence that they, if there's a new challenge or there's something new, are we able to access information for decision making? If we're not, then that's an issue. Do we have the support? If I'm able to speak up, if I have a problem, can I speak up and will my leader support me? Does my leader understand exactly what is going on with me? And they can bat for me. They can say, yes indeed, this is what's going on. And they can speak to the C-suite, they could speak to other departments, they can speak to other colleagues.

It's about having that support. And lastly, it's having a culture that embraces risk taking and innovation. You know, if I know something has not been working for 10 years, why do I have to wait 10 years to say I have the solution?

Host: Right.

Lindell Joseph, PhD, RN, FAAN, FAONL: I think what we would like to see is an environment where people will say, this is not working. I'd like to try this. And there's no red tape.

Host: And no pushback.

Lindell Joseph, PhD, RN, FAAN, FAONL: Exactly. So we have to be able to say to people, and we hear you, you have to be creative. Creativity is so important and that's why the other thing that's interesting about this work is that within the work group, we came up with a critical word that we believe is critical, right?

We believe that all leaders need to be inquisitive, and inquisitiveness is defined as a motivational attribute to engage in sincere questioning. How do we get people to become inquisitive? People have to feel like they belong. People have to feel like they're supported so they can question things. They can challenge things and feel supported that even though they were inquisitive, maybe the challenge or the solution they've proposed will be tested and we will actually have a solution.

Host: So something that actually gets suggested and is evaluated. Let me ask you this. You brought up some really good points. You talked about a nurse manager's council. You talked about support a couple times. All leaders need to be inquisitive. For a nurse leader listening to this podcast right now, how do they get started in doing this? What are the first steps they can take to build this culture of inquiry?

Lindell Joseph, PhD, RN, FAAN, FAONL: The first thing is to believe in yourself. I think one of the things that many nurse leaders, they may not have the confidence and the self-efficacy to say, I'm an expert. I know this information. I know this is not right. So it's about confidence. Believe in yourself because you are a catalyst for change. Therefore, you need to make the difference. So there were three things that we thought about. If you are a nurse leader say in the C-Suite, or whether you are a CNO or you were a director, and you need to create that culture, I think the key thing we need to understand is that creating a culture of inquiry is a trickle down effect.

Okay. It's a leadership effect. It's a workforce effect. So if I'm a CNO, there are three things I need to do. I need to make sure that I'm building connections. That's the first strategy. The second strategy is I need to make sure people feel psychologically safe. And thirdly, I need to ensure that people are utilizing design thinking.

Host: You said it starts at the top. It's a trickle down effect. We have to make those connections. We have to make a really safe work environment. And then the last thing you said number three, say that again. That was very interesting.

Lindell Joseph, PhD, RN, FAAN, FAONL: Design thinking.

Host: What is that?

Lindell Joseph, PhD, RN, FAAN, FAONL: Design thinking is about being deliberate and intentional in terms of how you problem solve. It's about if you need something new, whether it's a new idea, a new process, a new piece of equipment, it does not just happen. It's a deliberate and methodological process to come up with a solution in healthcare. So basically, when you engage in design thinking, it's a set of cognitive, strategic, and practical tools or procedures to help you think outside the box and to innovate.

Host: Being deliberate in your thinking and being very intentional.

Lindell Joseph, PhD, RN, FAAN, FAONL: Yes, absolutely.

Host: Design thinking, that is really, really great. So you where you implemented this or where you have tried this, have you seen results? Can you share an example?

Lindell Joseph, PhD, RN, FAAN, FAONL: Absolutely. There were different methods for design thinking. I could think of a simple one. It's called the scamper technique. S C A M P E R. And if you have a staffing issue, if you had to utilize scamper with your staffing issue, the first letter in scamper is S meaning what can I substitute? C, what can I combine? Because I have a staffing issue, can I put a different type of worker with the team? The A means is there something I could adapt? So when we think about A for adapting, you may consider probably saying to your nurses, well, during this shift, you may not necessarily, I will provide you with like a medication nurse to support you. Or maybe you won't to have to do discharges during your shift, so trying to use frameworks to help you problem solve and to think things through is really critical.

Host: So what was that acronym again?

Lindell Joseph, PhD, RN, FAAN, FAONL: S-C-A-M-P-E-R.

Host: So that's a, a use of design thinking is remembering the SCAMPER acronym. So when it comes to culture of inquiry, what is it that we should most remember when it comes to this?

Lindell Joseph, PhD, RN, FAAN, FAONL: I think the first thing is about building connections. Like I mentioned before.

Host: Mm-hmm.

Lindell Joseph, PhD, RN, FAAN, FAONL: It's about that relationship. You want to be able to connect to your people. You want people to feel that you care for them, that you support them. So you want to build a relationship. So it's about how do you provide affirmations when you see your people? Do you provide verbal affirmations? Do you tap them on the back? Do you give them verbal praise? What type of affirmations? Do you speak about the leadership and the impact and the outcomes of their leadership? What are some of those affirmations that you're going to communicate to them?

And with those affirmations, are you communicating those affirmations to the C-suite? So the C-suite, recognizes the impact of the manager. The C-suite recognizes the impact of the leader. So that alignment is really critical. Not only speaking and connecting with the leader face to face, but making sure you give the recognition voice, you give the recognition that witness so they could be acknowledged within the organization so they feel supported. So it's about that relationship.

Host: When somebody does that, you want to be able to take that recommendation or that thought and then show the employee that, hey we're thinking about it. We're evaluating it so that you at least understand that you are trying to move it up the chain of command. Is that right?

Lindell Joseph, PhD, RN, FAAN, FAONL: Absolutely. And that's the critical thing. We get so busy that we never provide that feedback. Because when people do not hear the outcome of the ideas or people do not see the result of the ideas, maybe could have been combined with something else. It is critical that we acknowledge.

Host: Right.

Lindell Joseph, PhD, RN, FAAN, FAONL: I would like my manager to come and say to me, Hey, Lindell, or my leader, we did take your idea, but we combined it with something else like in radiology or in a different department. Thank you for your idea. And that validates that you've been seen and you're visible, that I see you. We appreciate your ideas. So the next time I can then have that sense of comfort and confidence that I could say I could come up with a new idea. It's not just about having ideas and then you never know what happened to the ideas.

Host: It makes the person feel heard.

Lindell Joseph, PhD, RN, FAAN, FAONL: Absolutely. And I think that's what belonging is all about.

Host: Right.

Lindell Joseph, PhD, RN, FAAN, FAONL: It's wanting to be heard and then people could say, I'm heard, I will become inquisitive. I will question. I will challenge because people hear me.

Host: And that's a change someone could make right away, oh, you have an idea. Tell me more about it. How do you see it working? How do you think we would implement this? Okay. That's a great idea. Thank you for sharing that with me. I appreciate it. Let me talk with the person I would need to talk to to get this approved and then follow back up with that employee. I mean, that's a change someone could do right away today.

Lindell Joseph, PhD, RN, FAAN, FAONL: Absolutely. And that's the third strategy called psychological safety. It's the belief that people will be embraced, people will feel safe for being, for questioning things. And that's what culture is about in an organization. All we want, we in healthcare, the work we do in healthcare, we take care of patients, right? We're supposed to enable health, we're supposed to enable positive outcomes. And what we need is to have an environment where people are thriving. I think about years ago I came across, it's a classic book about images of an organization and one of the images of an organization is the brain.

And I think I could think about people navigating and working in an organization and thinking about the brain as the metaphor. We need people to be able to excel. We need people to be able to thrive, and that's impacted by the use of the brains. So what do we do to make sure people feel psychologically safe? People feel heard. People are not depressed, people are not despondent. So we need to provide them with tools, build those relationships, and allow them to feel safe so they can thrive. So we could impact health, we could impact the workforce and impact patient care.

Host: Yeah, that's a great point. A workforce that's thriving and feels supported ultimately provides better health. Isn't that right?

Lindell Joseph, PhD, RN, FAAN, FAONL: Absolutely. And remember we spoke about that alignment. So the way the leader experiences the work environment will impact the way the workforce, the frontline nurses experience the work culture and the climate. So when we talk about culture and climate, culture is the norms in the organization and the behaviors and the beliefs.

And if we have a culture where it's a culture of inquiry where people are building relationships, they're psychologically safe, they're utilizing design thinking; the climate then evolves where people are like, okay, I feel really good. I have a new idea I'm going to take to the manager. How do I get this idea to the C-suite? You know, it's about being recognized and feeling that support so they can thrive.

Host: And that's how you build better morale. That's how you lift everybody up.

Lindell Joseph, PhD, RN, FAAN, FAONL: Yes.

Host: When they feel that way. And that also then improves job satisfaction. People feel good about coming to work. They feel better about what they're doing. They feel better when they go home. So you're helping improve not only their professional life, I think their personal life too, cause they go home with a better mindset instead of, God, I can't take these people I work with. They have a better mental attitude too. So this really can help in a lot of ways. So, as we wrap up, Dr. Joseph, and thank you so much for your time. As we're talking about culture of inquiry, any last thoughts you want to make?

Lindell Joseph, PhD, RN, FAAN, FAONL: I think the key to a thriving workforce is really a culture of inquiry. I have been engaged in many discussions with frontline nurses, with nursing leadership. And I think providing people with venues so they can be heard, like professional governance or shared governance forums, providing people with information, the literature or information that you have as a leader in terms of maybe your budget, in terms of some of your challenges and providing people with resources. I think if we do some of these things, that transparency is really critical as we try to build those relationships and build those connections so people could feel supported, people could feel safe, and people can problem solve to transform healthcare into something we have not even envisioned.

Host: Yeah. This can be transformational.

Lindell Joseph, PhD, RN, FAAN, FAONL: Absolutely.

Host: Yeah. This is great stuff, so if you want to learn more about this it's in the Workforce Compendium. Check out the Culture of Inquiry. Dr. Joseph, thank you for being, here and talking with us. This has been great.

Lindell Joseph, PhD, RN, FAAN, FAONL: Thank you so much. It was my pleasure.

Host: Yeah, wonderful to have you here. Once again, that's is Dr. Lindell Joseph. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.