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I can't believe they said that about me! - Surviving union turmoil.

Recently, Children's Hospitals and Clinics of Minnesota, along with 13 other hospitals in the Twin Cities, went through some very serious and difficult negotiations with the Minnesota Nursing Association (MNA).

The MNA union in the Twin Cities had over 12,000 nurses willing to strike, which they did for one day on June 10,2010, and then almost had an open-ended strike on July 6, 2010. Thankfully, a few days before this the union and management agreed on a settlement that staved off the strike.

In my 34 years of being in this medical community there has only been one strike at Children's in 1984 that lasted almost five weeks, and it took us quite a long time to heal.

This 2010 strike, or the potential of it, also led to very significant hard feelings, bitterness and anger. While in 19841 was a new doctor in the community, this time I was sitting on the side of management as the chief medical officer and vice president of medical affairs of Children's. I was not directly involved in negotiations, but because of my position, I was distinctly considered on one side of the discussion.

What I experienced during this time was a fundamental attribution error, which is a problem I've heard about in the past but distinctly saw it manifest itself during the labor unrest.

During the negotiations I was made aware of two rumors/ statements that were making the rounds among nurses at Children's. Nurses were saying that I once stated that "any nurse with seven years or more experience should be let go and we should only hang onto the youngest nurses."

Four or five different nurses whom I've known for over 30 years called to ask me if this is really what I had said and could this be true. Nothing could have been further from the truth.

The fact that this rumor kept coming up bothered me significantly. I actually believe the story started by a presentation I made four months prior to a group of nursing union leaders about my views on quality and safety.

At that talk I asked the group, hypothetic-ally, if they had to make a choice between a doctor who is right out of training, one who is seven to 10 years out of training, or one who is 25 years post training, which would they choose.

Most typically pick a doctor who is seven to 10 years because they have a significant amount of baseline knowledge and experience, whereas the other two groups have either very little experience or are too dependent on experience.

I asked the nurses at that meeting a similar question about who you would want for your nurse.

At no time did I ever say or suggest that we should get rid of older nurses. After all, the nurses I've known for more than 30 years are professionals who are unbelievably astute, compassionate, hardworking, and I would allow them to care for my family.

Union buster

Another story making the rounds was that the CEO, who came from Canada more than seven years ago, was hired by the board of directors to bust the union. Again, there were no facts, just attributions.

Actually the CEO's job was to make this a top-flight children's hospital and to try to merge with one of our competitors. At no time in the seven years that I've known him has he ever said anything about busting a union.

So why do these rumors occur? Why is it that people seem to make up stories based upon no facts.

Social psychologists call it fundamental attribution error. My wife, a child psychologist, reminded me how prevalent this is. The classic study on fundamental attribution error was developed by Edward E. Jones and Keith Davis in 1967, when they hypothesized that people would attribute freely chosen behaviors to disposition and chance directive behaviors to situation.

While there is no universally accepted explanation for fundamental attribution errors, there are several hypotheses.

1. The just-world phenomenon is the belief that people get what they deserve and deserve what they get. This is where you attribute failures to dispositional causes rather than situational causes that are unchangeable and uncontrollable. It satisfies our need to believe that the world is fair and that we have control over our lives.

2. Salience of the actor is where people attribute facts to potential causes that capture their attention. When we observe other people, the person is the primary reference point while the situation is overlooked as if nothing but mere background. So attribution for others behaviors are more likely to focus on the person we see but not the situational forces acting upon that person that we might not be aware of.

There are basically two sources of our behavior, those influenced by situational (external) factors and those influenced by dispositional (internal) factors. Fundamental attribution error refers to the tendency to overestimate the internal and underestimate the external factors when explaining the behaviors of others.

This may be a result of our tendency to pay more attention to the situation for ourselves rather than to the individual, and is especially true when we know little about the other person. For example, the last time you were driving and got cut off did you say to yourself, what an idiot or did you assume the other driver must be having a rough day?

3. Lack of effortful adjustment -Sometimes even though we are aware the person's behavior is constrained by situational factors, we still commit the fundamental attribution error. This is because we do not take into account behavioral and situational information simultaneously to characterize the dispositions of the actor.


Similar to this is the self-serving bias. A self-serving bias occurs when people attribute their successes to internal or personal factors but attribute their failures to situational factors beyond their control.

For others, this is the exact opposite because when they have successes you tend to attribute those successes to situational factors, but when they have failures you tend to attribute them to internal and personal factors.

Western culture exacerbates this attribution error as we emphasize individual freedom and autonomy and our socialized preferred dispositional factors to situational ones.

An example would be when you are evaluating someone else, you may be thinking he or she has not done much today because the person is lazy, rather than that the individual is tired or lacks the right resources.

Westerners tend to believe much more in attribution theory because of the belief that the individual has much more liberty of action, while people in Asia perceive the behavior as internally rather than externally caused. Westerners tend to see themselves as independent, whereas people in the eastern hemisphere see the opposite.

So what?

In the end, you need to be aware of people blaming you for things outside of your control. Also watch out for you doing it to others. You need to watch how others make attributions. When they seem to go against the trend and be in your favor, be curious about their motive.

A number of biasing techniques have been found effective in reducing the effect of fundamental attribution error.

* Take heed of consensus information; if most people behave the same way when put in the same situation then a situation is more likely to be the cause of behavior.

* Ask yourself how you would behave in the same situation.

* Look for unseen causes, specifically look for less salient factors.

The fact is we are always being bombarded with peoples' biases in their thinking as in our own. Fundamental attribution error is just one of many, but a very powerful one when people are feeling defensive.

Over the past year since the labor unrest, the leadership team at Children's has worked very hard trying to heal and re-establish trust with our nursing partners.

We have had quarterly staff "Town Hall" meetings with open and frank conversations. The leadership team individually has made weekly walking rounds to all of our units. We have made a concerted effort to communicate more by using multiple modalities in the hope and desire to create an environment where attribution doesn't occur because of mutual trust and knowledge of each other.

I hope it continues in this direction. We need each other too much, as do our patients.

Phillip M. Kibort, MD, MBA is vice president of medical affairs and chief medical officer at Children's Hospitals and Clinics of Minnesota.


By Phil Kibort, MD, MBA
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Title Annotation:Labor Movement
Author:Kibort, Phil
Publication:Physician Executive
Geographic Code:4EUUK
Date:Jul 1, 2011
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