How to speak up — even when you don’t want to | Sarah Crawford-Bohl

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4:02I've brought up my late friend and mentor, Kathy Phillips, before on this podcast. She had a profound impact on my life, and the lessons I've learned from her remain with me to this day. One of the things she often talked about was the importance of sticking your neck out and engaging in difficult conversations, even when you don't really want to. She had a mantra for this that I'll always remember. If not you, then who? If not now, then when?

4:35I'm Madupa Akinola. This is TED Business, a podcast from TED. Our speaker today is healthcare leader Sarah Crawford-Bowell. Her North Star is her late mom, an intensive care nurse who was no stranger to difficult conversations. Today, Sarah will share some of the wisdom she learned from her mother and give concrete advice on how to speak up. Then after the talk, I'll reflect on some more sound advice from my colleagues. But first, a quick break.

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7:43Sarah Crawford-Bowell now takes the TED stage. Silence. It can be a needed moment of peace and contemplation. But what happens when silence becomes a barrier? A barrier that muffles the voice of truth, of advocacy, of change. Speak up. Advocate for yourself. Stand up for what you believe in. That's what they say, right? Well, even though I know they're right, it's easier said than done. I'm sure we can all think of a time when we faced a crossroads, perhaps the precipice of an uncomfortable conversation, when speaking up felt like the right, if not even essential path. But silence seemed safer.

8:45I can vividly see and feel myself being in those moments. Times when I stood red-faced, embarrassed or offended, frustrated or angry. With a sinking feeling in my stomach. Unable to find my voice. And unsure if I had the courage, confidence, or will to face the difficult conversation before me. Sound familiar? We're not alone. Research from VitalSmarts, a global leader in organizational performance and leadership, tells us people would rather quit their jobs than address a challenging situation. In this post-pandemic time, with baby boomers retiring and a wave of quiet resignation upon us, the world seems to be working short-staffed.

9:41I'm a nurse and have worked in healthcare leadership for a long time. And I'm here to tell you, in this profession, we can't risk losing anyone. Especially not for the reason of avoiding a challenging conversation. In a world where we are experiencing increasingly rapid cycles of change, we can expect difficult conversations, particularly in the workplace, to happen more often than ever before. Moments such as sharing feedback, identifying mistakes, or calling out disrespect. They're not always easy, but often critical to the performance of both individuals and a team. In healthcare, where stakes are high, our willingness to raise concerns can be vital to the quality of care we provide, but also to the safety of patients and the care team.

10:34In fact, research also tells us that when we do speak up, we experience more job satisfaction, increased team morale, and in my world, support better patient outcomes. I've experienced this for myself. Now, I don't have all the answers, and I don't always get it right. In fact, I make a mess of it sometimes. But often I've found it's a bit like cardio or weightlifting. Well, we feel a bit vulnerable at the time. With practice, we start to experience the benefits. It gets easier, and we get better at it. We need to find a path to help us get past that initial fight, flight, or freeze response to get us to the table and make leaning into uncomfortable conversations the desired action for our own benefit, as well as to benefit those around us.

11:37Now, I was fortunate. I had some amazing role modeling by parents who encouraged me to use my voice, specifically one I knew I should, but didn't want to. My mom, an intensive care nurse for many years, had a special ability to address tough topics, traumas, embarrassing bodily functions, or sharing critical feedback. She always created airtime for normally avoided matters. With a fierce moral compass that was sometimes incredibly frustrating, she advocated for what was right, showing me the importance of standing up for oneself, and others, even when uncomfortable to do so. My mom, she died a long time ago now, and I still miss her desperately.

12:35Something I think I miss the most, though, is her always knowing the right thing to do and the way she guided me with that moral compass. And despite having a couple of degrees under my belt, lessons learned from that moral compass they guide me more than any of my formal learning. She showed me that as leaders, and I mean all leaders, both formal and informal, we play a pivotal role in leaning into courageous conversations and creating a safe place for others to do the same. It's probably her strong commitment in this area that inspired me to go into healthcare leadership, a path that often puts me in an area of high conflict and tricky conversations.

13:22but in doing so exposes me to innovation, change-making, and meaningful work. It's an incredible career that I'm honored to be a part of, and I owe it to my mom and myself to do it well. So when I find myself needing courage and confidence, making that momentous step into the abyss of a difficult conversation, I try to remember my mom's moral compass. and the principles she worked so hard to nurture in me. I imagine holding a compass in my hand, the cool metal upon my skin, taking a breath, a moment to pause and ground myself. I see the directions of north, south, east, and west as symbols, reminders of her core teachings.

14:20North. I think about the North Star, a guide towards the good and right thing to do. In tricky situations, I remember my mom's voice. Be the best version of yourself. Take the high road. Say what needs to be said.

14:38South. The S in South reminds me of support. When people support me, I feel seen, cared for. When it comes to supporting others, I try to do the same. Leaning into tricky conversations with kindness and an intention of helping people grow. And EAST, the E stands for empathy. Empathy sets the tone for a conversation. As a leader, I want people to feel safe coming to me. I try to understand their feelings and create a safe place for them to be themselves. And West, the W stands for wonder, getting curious about what might be going on for the other person. I ask questions and listen, so I understand before trying to be understood.

15:37When I focus on the principles of the compass, I'm able to move from reactive to proactive, getting into a mindset where I can be true to my values and share my voice. I recall a situation not long ago where I was able to put the compass to use. I was in a change management and communications role for a big project. And while the work was complex and bumpy, I was proud of myself. while just writing good stuff, inspiring hearts and minds. Or so I thought. One day, a physician came into the office where I was meeting with my boss, my boss's boss, and a number of other leaders. He had one of my newsletters printed out and was waving it in the air.

16:21Who is the cheerleader sending out this stuff? As an optimist, sometimes to a fault, I knew right away that cheerleader was me. While I was embarrassed, I had a split second to decide. Stay silent or speak up. The compass came in handy in that moment. North Star, what was the good and right thing to do? Well, I needed to own my work, take the feedback. So I said, that would be me. He lowered his arm and said, well, this is too positive, not an accurate representation of what we're going through. While still defensive, I remembered support and empathy. I wanted to create a safe place where he could feel seen and heard.

17:18So I suggested we sit down together so he could better understand his concerns. Next step, wonder. We went to his office, and I asked curious questions. And over some tea, he told me his story. He got out a red pen and circled the nine times I'd mentioned something positive in that article.

17:43I acknowledged. It was too many, understandably devaluing. I then asked if we could look for times I'd mentioned challenges. To his surprise, and frankly my own, 18 times. 18. I'd mentioned things that needed to be fixed. I was able to let him know I was embarrassed by being called out in front of my superiors, and he apologized. You know, that time spent together, it was valuable for me, and I think we both took something meaningful away. So I always remember the moral compass. North, North Star, South Support, East Empathy, and West Wonder. I know when I'm true to my compass, I'm courageous, confident, the person I want to be, and I think the daughter my parents would be proud of.

18:46And with my husband and our two daughters, I get the chance to pay it forward. So I hope you'll join me in leaning into tricky conversations, not only finding our voices, but understanding the imperative to use them. Stand up against the wrong, champion the right, and be the voice for those who cannot speak for themselves. No matter how shaky or unsure, we can be a powerful instrument of change and advocacy, leaving all people involved stronger as a result. Thank you.

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21:35That was Sarah Crawford-Bowell speaking at TEDxRRU. I love Sarah's image of the COMPASS and the acronym she's created from it to ground herself in a delicate conversation. One of the hardest times to speak up is when we've messed up and we're the ones who need to swallow our pride, take accountability for our actions, and apologize. And my colleague Adam Golinski has an acronym for this too. Q-O-R-C, or as he likes to call it, Quarka Crisis. I'll break it down for you. Q is for quick. Make sure you can apologize as soon as you can so there's no time for conflict to fester. O is for open. Be candid and open in your apology.

22:21R is for responsibility, as in take responsibility and focus on the other person and how it might have affected them. And finally, C is for commit. Commit to change. Let them know what you might do differently next time or in the future. It's okay if you need a little pep talk or a small map to help guide you through a difficult interaction. And if you can, try to remember that the beauty of difficult conversations is that they can actually be transformational. That's it for today. TED Business is part of the TED Audio Collective. This episode was produced by Hannah Kingsley-Ma, edited by Alejandra Salazar, and fact-checked by Julia Dickerson.

23:09Special thanks to Maria Ladias, Farah DeGrange,

23:18I'm Madupa Akinola. Thanks for listening.

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