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Radha Samson and Drew Johnson sat facing each other at the end of the long conference table in St. Sonia's Business Office. They had paper and open computers in front of them, as well as cups of hot hospital coffee. They were preparing for their joint presentation to the hospital board on the effects of three years of The Exchange process at St Sonia's Hospital.

Radha began by suggesting:

Let's start with the stories. If our goal is to demonstrate that we now operate—pun intended—in a different culture than we did three years ago, we need to set the scene. We can get to the factual evidence and the bottom line later; but I want them to really understand how and why it is so powerful.

Drew responded:

I agree. We can't talk about the private conversations because of confidentiality, but we can certainly talk about the resulting changes in protocols, procedures, and policies that have resulted.

Radha added:

Yes, and the people. The people: those who have been affected by participating and the facilitators who have been part of the process and part of the joint problem solving.

Drew continued:

Okay, let's start with a few of the most influential cases. We've talked to each other about some of those and I think we need to include Kim Brown's case about the nurses' station as well as the couple that the Patient Relations Department facilitated.

Radha was organizing in her head as she remembered what a long way they had come from the first training session, three years ago, and the skepticism she and the other team members had faced from the hospital board and from the department heads. Radha suggested:

So let's pick eight or ten more dramatic ones. By that I mean the ones that affected the most people, and focus on the results of each.

After a few minutes of brainstorming, they decided to pick:

  • Two classic cases involving one manager and two employees

  • Two cases illustrating how to work with groups

  • Two cases involving patients as participants

  • Two cases focusing on patient families

  • Two cases involving disruptive individual employees

These were the cases they chose:

  • Room Transfer. One of Radha's first cases between RN Kim Brown and hospital financial donor and patient, Marvin Yee (Chapter 11). The resolution of the conflict over responsiveness of staff and patient input had included a new protocol that assured patients that they had been heard and gave nurses and other staff members a chance to make reasoned decisions. It had also resulted in Kim taking The Exchange training and becoming one of the hospital's most competent facilitators. Because of his experience, Mr. Yee had made a special donation to The Exchange ...

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