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8.2 What are the principles of 'calling it out with compassion'? (Second messenger system)

Here we expand on ‘Calling it out with compassion’, which is an example of an established second messenger system for calling out poor workplace behaviours.

‘Calling it out with compassion’ is an adaptation of the second messenger system first modelled by Gerald Hickson at Vaderbilt University School of Medicine. Instead of the behaviours being called out by the people who were directly involved in the incident either as the recipient or witness it is addressed by a second messenger with the view that people do not come to work to deliberately harm each other.

In April 2021, we hosted a conversation with Chris Turner, founder of Civility Saves Lives, where he shared his experience and knowledge backed by evidence on this topic.

The conversation has been divided into 3 short videos for the ease of the user, especially as you may wish to revisit specific parts of the conversation at a later stage. The videos are followed by the key content in written format.


In conversation with Chris Turner

Includes a brief insight into the Civility Saves Lives campaign before diving into an explanation.

Video 1: Welcome and Introduction: of the principles behind having a compassionate, non-judgemental conversation using the second messenger system.

Video 2: In conversation with Chris Turner Q&A: who, when and pitfalls and practicalities

Video 3: How might you implement a second messenger system in your department

The second messenger system

2 purposes

  • Care about the person you are talking to
  • Land the information

3 parts

  • Check in: ‘How are you?’ Show that you really want to check that they are ok and listen.
  • Enquire: Use an open-ended question to get their side of the story.
  • Deliver the messenger: ‘They were upset and I know that you would want to know’. Trust that they will do the right thing.

Who and when, pitfalls and practicalities

Short notes on each section of Video 2 are highlighted in the text as reminders but are not a replacement for watching the videos which are packed full of important information and guidance. 

Who should do the ‘calling it out’? (0-4 mins of video)

  • Emphasises the importance of training, thought and structure.
  • Ideally 2 second-messengers at each level to allow peer to peer conversation devoid of hierarchy

Is there a best time to have the conversation (4mins -6m30s of video)

  • Very situation dependent but ideally as close to the incident as possible but not necessarily in the moment. Consider the clinical environment and therefore patient safety in the timings.

Are there any phrases to use or avoid? (6m30s to 11m20s of video)

  • Ensure there is an overarching sense that you are caring for this person.
  • Do not retell the story you have heard.
  • Remember the ‘3 parts’ of the conversation described above.

Have you been in a situation where the conversation has gone badly? (11m22s to 16m58s of video)

  • Chris reflects on a conversation he had that escalated. 

Do the second messengers get a bad reputation? (17mins to end)

  • This is avoided by a voting-in/nominating system and the fact that the conversations are steeped in compassion and kindness.

How might you implement a second messenger system in your department

How could we institute the second messenger system in our department? (3min 30s of video)

  • First make sure people believe that behaviour matters (the Civility Saves Lives message) and that most people are not deliberately rude in the workplace. Suggest a ballot system where peers suggest colleagues they think would be good at the role then approach those who have been ‘voted-in’ to see if they want to take on the role. Finally, provide them with training and support.

Would you keep a record of the conversation? (3m30s to 6m40s of video)

  • This is an informal process but there is a need to identify repeat offenders, suggest keeping a record of who conversations have been had with but without specific details.

How do you bring compassion into the formal processes? (6m40s to 11m55s)

  • It is essential to employ formal process when serious incidents occur or when negative behaviours persist despite repeated peer-to-peer interventions.  However, compassion can still be part of that conversation.