HBR: Making Time to Really Listen to Your Patients

Do you think the following concepts around patient care can be applied to the building supply industry? What is the cost of hurried encounters with your customers? Below is a blog from the Harvard Business Review by Leonard L. Berry and Rana L.A. Awdish:

Making Time to Really Listen to Your Patients

Modern medicine’s true healing potential depends on a resource that is being systematically depleted: the time and capacity to truly listen to patients, hear their stories, and learn not only what’s the matter with them but also what matters to them. Some health professionals claim that workload and other factors have compressed medical encounters to a point that genuine conversation with patients is no longer possible or practical. We disagree.

Our experiences — as a critical-care physician whose own critical illness led her to train physicians in relationship-centered communication (Rana Awdish) and as a health services researcher who has interviewed and observed hundreds of patients, doctors, and nurses (Len Berry) — teach us that hurried care incurs hidden costs and offers false economy. In other words, it might save money in the short term but wastes money over time.

Why Listening Matters

Actively listening to patients conveys respect for their self-knowledge and builds trust. It allows physicians to assume the role of the trusted intermediary who not only provides relevant medical knowledge but also translates it into options in line with patients’ own stated values and priorities. It is only through shared knowledge, transmitted in both directions, that physicians and patients can co-create an authentic, viable care plan.

A doctor’s medical toolbox and supply of best-practice guidelines, ample as they are, do not address a patient’s fears, grief over a diagnosis, practical issues of access to care, or reliability of their social support system. Overlooking these realities is perilous, both for the patient’s well-being and for efficient delivery of care. We believe not only that a clinician should share medical decision making with the patient but also that it must occur in the context of an authentic relationship.

The Costs of Hurried Encounters

Compressed medicine has real risks. Clinicians become more likely to provide ineffective or undesired treatment and miss pertinent information that would have altered the treatment plan and are often blind to patients’ lack of understanding. All of this serves to diminish the joy of serving patients, thereby contributing to high rates of physician burnout. These consequences have clear human and financial costs.

The medical literature increasingly offers potential solutions to the inefficiencies that rob patients of physicians’ time and attention, including delegating lower-expertise tasks to non-physician team members, improving the design of the electronic health system, and greatly reducing the paperwork bureaucracy that adds little or no value. We can create more space for active listening. Unhurried medical care may be elusive, but it is practical.

Reimagining Roles

Beyond time pressures, the typically unquestioned roles that physicians and patients assume also inhibit relationship-building. In their medical training, physicians often are taught to maintain a clinical distance and an even temperament. They are warned not to get too close to patients, lest they internalize the suffering and shoulder it themselves. The best physicians, we know, reject this advice because it diminishes their humanity and disadvantages their patients, who need more than a highly-qualified body technician, especially when they’re seriously ill.

Patients learn roles, too: adhere to the doctor’s plan, squelch errant thoughts that might sound foolish, don’t ask too many questions, defer to the expert, be “a good patient.” In a new article we co-authored with others, we show that many patients, especially those with serious disease, behave like hostages in the presence of physicians — unwilling to challenge authority, understating their concerns, requesting less than they desire. Most physicians certainly don’t want patients to feel like hostages, but the patients often do. When patients feel like hostages, the ideal of shared decision making is a pipe dream.

It’s no wonder, then, that for patients with serious illness, the emotion they most often cite is “overwhelmed.” The diagnosis, the options, the treatment, the myriad side effects, the change in identity when living with disease — all of it can indeed be overwhelming. In this complex, fraught situation, people need a compassionate guide — a wise, comforting sherpa who knows the mountain, the risks of various routes, the viable contingency plans. The physician-sherpa should be a partner on the journey, not simply a medical operative, extracting formulaic rules and implements from a toolbox. Patients need and deserve much more.

When doctor and patient join forces, the team dynamic dismantles the harmful hierarchy. Both members of the dyad can rely on each other because neither owns all the data that matter. Speaking at a White Coat ceremony for medical students, Dr. Rita Charon, a pioneer in the rising discipline of narrative medicine, stated:

I used to ask new patients a million questions about their health, their symptoms, their diet and exercise, their previous illnesses or surgeries. I don’t do that anymore. I find it more useful to offer my presence to patients and invite them to tell me what they think I should know about their situation.…I sit there in front of the patient, sitting on my hands so as not to write during the patient’s account, the better to grant attention to the story, probably with my mouth open in amazement at the unerring privilege of hearing another put into words — seamlessly, freely, in whatever form is chosen — what I need to know about him or her.

An Organization that Listens and Heals

Not hearing the patient’s voice harms the patient and the clinician. They don’t have the benefit of pooled knowledge, ability to make fully informed mutual decisions, or time to build trust. Health systems that want to avoid those pitfalls need leaders who invest in shaping an organizational culture that values hearing patients’ voices. Here are some steps such organizations might take:

  • Share patient stories and related lessons at every meeting. Perhaps one should be a story of success (what we did well for a patient) and another of a failure (where we must improve).
  • Offer a communications curriculum to clinical and non-clinical staff. The professional development should be engaging and dynamic so that adult learners seek it out because they view it as worthwhile.
  • Encourage and reward clinical curiosity, whereby generous questions are asked to elicit generous patient responses. Emphasize listening for not just what is said, but also how it is communicated. Consider a narrative-medicine component.
  • Convene patient advisory boards that meet regularly with practice leaders to convey concerns and make suggestions about improving patients’ experiences.
  • Use multiple methods to identify and systematically address impediments in clinicians’ daily work — the “pebbles in the shoes.” Examples include rounds, conducted by senior leaders, with both staff and patients; staff focus groups and anonymous surveys; and CEO feedback meetings with small groups who speak openly about what prevents them from delivering better care.
  • Create a balanced scorecard of physician performance that tracks not only productivity but also professional development, team building, safety and quality metrics, timeliness of care or access, communication skills, and care coordination — measures that matter to patients.

A Way Forward

Medicine is constantly evolving as new ways to treat, heal, and even cure emerge. We must continually reflect on the changes, and correct the course as needed. This work cannot happen in a vacuum of forced efficiency. Physicians, patients, and administrators all must maintain and build on what is sacred and soulful in clinical practice. We must listen generously so that we nurture authentic, bidirectional relationships that give clinicians and patients a sense of mutual purpose that no best-practice guideline or algorithm could ever hope to achieve.

Advertisements

JoA: 5 Things Leaders Should Never Say

How’s is your communication with your directs? Are you pushing them away? Below is an article form Journal of Accountancy magazine By Jennifer Wilson.

5 Things Leaders Should Never Say

To avoid alienating your employees, especially your best young talent, try these alternative approaches for better communication.

Today’s –coming leaders have many career options, and their phones, email inboxes, and LinkedIn accounts are being “hit up” every day by recruiters and others interested in potentially employing them. That’s why established leaders committed to retaining their best and brightest need to pay more attention to the things they say that frustrate and disappoint future leaders.

This article explores five phrases established leaders should never say again and suggests an alternative approach that their young or new talent might better appreciate. And while the advice in this article is geared toward conversations with young CPAs, leaders would be -advised to apply it when communicating with all team members.

Never say this again Be patient …

Why? Because … Up-and-coming leaders have many options. When you tell them to be patient about something they want changed, they hear, “This isn’t going to happen for a long time (if ever),” and they don’t want to—or have to—wait.

Try this instead: When your people want something to change, ask them to develop a plan to make it happen. Then, help them refine their ideas and do your best to support them in implementing the change unless the change is a monumental deal breaker. Be willing to pilot new ideas, take small steps, and implement things imperfectly to ensure that your team feels perpetual forward progress.

Never say this again: You’re not ready …

Why? Because … Emerging leaders want experiences. Most have confidence in their abilities, and they want to progress faster than traditional timelines. Your best and brightest don’t want to be held to “old” timing standards of what a “- person” or a “new manager” does. Instead, they want to do what they believe they are ready and able to do. When you say they’re not ready, they hear you saying, “I don’t believe in you yet,” which contradicts their own beliefs. This leaves them thinking, “You don’t get it” or “You don’t get me.”

Try this instead: Figure out how to get them a portion of the experience they’re requesting or allow them to take on the whole effort. For instance, if they feel they are ready to meet with tax clients, allow them to do so. Ensure that a member of your team acts as a silent shadow for the first few meetings. In my experience, today’s emerging leaders are often more ready than we expect—which is great news! When they try and don’t succeed, most are quick to admit they need to step back and invest to round out their skills. While they’re regrouping, they’ll appreciate that you took the risk and believed in them.

Never say this again: When I was coming up … That’s not how it was when I came up …

Why? Because …They hear you saying, “Four score and seven years ago …” or “I am old.” I realize that’s harsh, but if you hark back to your days as an emerging leader, you rolled your eyes when your boss said this, too! Back in the day, people churned butter and used outhouses. But they don’t have to anymore. Today’s emerging leaders don’t want to talk about yesterday’s hardships—they want to talk about tomorrow’s possibilities!

Try this instead: Ask yourself what you’re trying to convey in a story about the past or your career progression. Instead of using the offending phrases, try something like, “What I have learned that works well is …” or “A best practice we employ is …”

Never say this again: He must not be working because he isn’t here … or She isn’t putting in the same effort as others because she leaves at 4:30 p.m. or isn’t here on Saturdays …

Why? Because … It is a fallacy that people are productive contributors just because they’re in the office. It is possible that your people are working from home, clients’ offices, or other locations at odd hours and producing a lot of great work when they are not in the office. In fact, according to Gallup’sState of the American Workplace report, remote workers logged more hours than their office counterparts and were slightly more engaged. Emerging leaders value flexibility in where and when they work. The offending phrases make them think, “You really don’t get it.”

Try this instead: Look for ways to further your workplace flex programs. Ask your emerging leaders to devise strategies to maximize both production and flexibility. Encourage all employees to stop equating presence at the office with productivity because the correlation is false. And, if you want to learn more about the argument emerging leaders have for virtual work, read my blog post at convergencecoaching.com.

Never say this again: You can change this when I’m gone (sometimes said jokingly, but not heard that way!)

Why? Because … This is similar to “be patient” but has the extra kick of reminding your emerging leaders that you are on your way out, biding your time, bailing, or any other number of “short timer” ideas. And this can cross their minds, “So, we won’t change this important thing because you don’t want to, and the firm will suffer until you leave. Then, we’ll have to scramble to be competitive.” This leads them to want you gone sooner—and you wonder why you feel pushed? When your resistance persists, it can lead to this thought you never want to enter your future leader’s mind, “Why don’t I leave before you and save us both the trouble?”

Try this instead: Our profession is facing immense change in almost every area. For firms, those changes include shifting work styles such as dress and flexibility, the fight for relevance in compliance services, changes in billing practices, the emergence of advisory services, and leaps in technology. Evolution isn’t optional. Your emerging leaders want to capitalize on these changes and position your business for success. Step outside of your discomfort, reignite your passion, and put your immense experience to work to support your team in making the big changes needed—now.

SPEAKING TO THE FUTURE

As a Baby Boomer, I understand the feelings that established leaders might have as they read this article. You want to enjoy the fruits of your labor as you appreciate the view from your career pinnacle. You want things to be familiar and perhaps the way they’ve always been. But that’s like wishing you could do business in a market that doesn’t exist instead of actually doing business in the market you’re in. If you’re committed to having succession in place to ensure that your business succeeds well into the future, give up the notions—and phrases—that send signals of resistance to your emerging leaders. Reignite your inner revolutionary. Embrace their ideas. Engage with them in change.

This article is adapted from “5 Phrases Established Leaders Should Never Say Again,” CPA Insider, Aug. 1, 2016.

About the author

Jennifer Wilson (jen@convergencecoaching.com) is a partner and co-founder of Convergence-Coaching LLC in Bellevue, Neb.

 

How to Conduct a Business Meeting

Business meetings are often unproductive. The following outlines some tips to help ensure a productive meeting. There are three importance things to determine before scheduling a meeting: purpose, agenda, and people.

Purpose

The purpose of the meeting should be clearly stated and communicated to participants. Both the agenda and materials should be sent to all members before the meeting. Let everyone know that the materials should be reviewed prior to the meeting and to come prepared to discuss the topics at hand. Discussions at meetings are important and silence may denote that you’re in agreement with the topic. Ground rules should be made clear.  These may include things such as no cellphones or laptops allowed in the meeting. Also, the meeting should start on time, so arrive 5 to 10 minutes early to network beforehand.

Agenda

The agenda is used to guide the meeting. Each agenda item should have a designated amount of time noted on the agenda either written in minutes or beginning time (3:15pm). An alternative approach is to use a shot-clock which is a timer used to countdown the minutes.

You may want to assign someone to take notes for the meeting. These notes can be either formally typed up and distributed after the meeting or simply make a copy or take a picture of the handwritten notes and email them to the group.

The notes should include the agreed upon action items and assignment of those task s to a responsible party. As a group leader you will need to follow up with the individual responsible for all action items before the next meeting.

People

The last item, but perhaps the most important is deciding who should attend the meeting. There isn’t any magic number on the number of attendees. However, many recommend no more than 6-8 people or you can use Jeff Bezos’s two pizza rule; limit participants to the number two pizzas would feed. Involve those who have a stake in the agenda and will add value. Finally, at the end of the meeting there should be a recap of the results of the meeting, next time steps to be taken, and the responsible party for those actions.

A little extra planning can go a long way to increasing the productivity of any meeting.

HBR: What Great Listeners Actually Do

Which level of listening would you like to aim for? Are you using all four qualities to listen? Below is a blog from the Harvard Business Review by Jack Zenger and Joseph Folkman.

What Great Listeners Actually Do

Chances are you think you’re a good listener. People’s appraisal of their listening ability is much like their assessment of their driving skills, in that the great bulk of adults think they’re above average.

In our experience, most people think good listening comes down to doing three things:

  • Not talking when others are speaking
  • Letting others know you’re listening through facial expressions and verbal sounds (“Mmm-hmm”)
  • Being able to repeat what others have said, practically word-for-word

In fact, much management advice on listening suggests doing these very things – encouraging listeners to remain quiet, nod and “mm-hmm” encouragingly, and then repeat back to the talker something like, “So, let me make sure I understand. What you’re saying is…” However, recent research that we conducted suggests that these behaviors fall far short of describing good listening skills.

We analyzed data describing the behavior of 3,492 participants in a development program designed to help managers become better coaches. As part of this program, their coaching skills were assessed by others in 360-degree assessments. We identified those who were perceived as being the most effective listeners (the top 5%). We then compared the best listeners to the average of all other people in the data set and identified the 20 items showing the largest significant difference. With those results in hand we identified the differences between great and average listeners and analyzed the data to determine what characteristics their colleagues identified as the behaviors that made them outstanding listeners.

We found some surprising conclusions, along with some qualities we expected to hear. We grouped them into four main findings:

  • Good listening is much more than being silent while the other person talks. To the contrary, people perceive the best listeners to be those who periodically ask questions that promote discovery and insight. These questions gently challenge old assumptions, but do so in a constructive way. Sitting there silently nodding does not provide sure evidence that a person is listening, but asking a good question tells the speaker the listener has not only heard what was said, but that they comprehended it well enough to want additional information. Good listening was consistently seen as a two-way dialog, rather than a one-way “speaker versus hearer” interaction. The best conversations were active.
  • Good listening included interactions that build a person’s self-esteem. The best listeners made the conversation a positive experience for the other party, which doesn’t happen when the listener is passive (or, for that matter, critical!). Good listeners made the other person feel supported and conveyed confidence in them. Good listening was characterized by the creation of a safe environment in which issues and differences could be discussed openly.
  • Good listening was seen as a cooperative conversation. In these interactions, feedback flowed smoothly in both directions with neither party becoming defensive about comments the other made. By contrast, poor listeners were seen as competitive — as listening only to identify errors in reasoning or logic, using their silence as a chance to prepare their next response. That might make you an excellent debater, but it doesn’t make you a good listener. Good listeners may challenge assumptions and disagree, but the person being listened to feels the listener is trying to help, not wanting to win an argument.
  • Good listeners tended to make suggestions. Good listening invariably included some feedback provided in a way others would accept and that opened up alternative paths to consider. This finding somewhat surprised us, since it’s not uncommon to hear complaints that “So-and-so didn’t listen, he just jumped in and tried to solve the problem.” Perhaps what the data is telling us is that making suggestions is not itself the problem; it may be the skill with which those suggestions are made. Another possibility is that we’re more likely to accept suggestions from people we already think are good listeners. (Someone who is silent for the whole conversation and then jumps in with a suggestion may not be seen as credible. Someone who seems combative or critical and then tries to give advice may not be seen as trustworthy.)

While many of us have thought of being a good listener being like a sponge that accurately absorbs what the other person is saying, instead, what these findings show is that good listeners are like trampolines. They are someone you can bounce ideas off of — and rather than absorbing your ideas and energy, they amplify, energize, and clarify your thinking. They make you feel better not merely passively absorbing, but by actively supporting. This lets you gain energy and height, just like someone jumping on a trampoline.

Of course, there are different levels of listening. Not every conversation requires the highest levels of listening, but many conversations would benefit from greater focus and listening skill. Consider which level of listening you’d like to aim for:

Level 1: The listener creates a safe environment in which difficult, complex, or emotional issues can be discussed.

Level 2: The listener clears away distractions like phones and laptops, focusing attention on the other person and making appropriate eye-contact. (This behavior not only affects how you are perceived as the listener; it immediately influences the listener’s own attitudes and inner feelings. Acting the part changes how you feel inside. This in turn makes you a better listener.)

Level 3: The listener seeks to understand the substance of what the other person is saying. They capture ideas, ask questions, and restate issues to confirm that their understanding is correct.

Level 4: The listener observes nonverbal cues, such as facial expressions, perspiration, respiration rates, gestures, posture, and numerous other subtle body language signals. It is estimated that 80% of what we communicate comes from these signals. It sounds strange to some, but you listen with your eyes as well as your ears.

Level 5: The listener increasingly understands the other person’s emotions and feelings about the topic at hand, and identifies and acknowledges them. The listener empathizes with and validates those feelings in a supportive, nonjudgmental way.

Level 6: The listener asks questions that clarify assumptions the other person holds and helps the other person to see the issue in a new light. This could include the listener injecting some thoughts and ideas about the topic that could be useful to the other person. However, good listeners never highjack the conversation so that they or their issues become the subject of the discussion.

Each of the levels builds on the others; thus, if you’ve been criticized (for example) for offering solutions rather than listening, it may mean you need to attend to some of the other levels (such as clearing away distractions or empathizing) before your proffered suggestions can be appreciated.

We suspect that in being a good listener, most of us are more likely to stop short rather than go too far. Our hope is that this research will help by providing a new perspective on listening. We hope those who labor under an illusion of superiority about their listening skills will see where they really stand. We also hope the common perception that good listening is mainly about acting like an absorbent sponge will wane. Finally, we hope all will see that the highest and best form of listening comes in playing the same role for the other person that a trampoline plays for a child. It gives energy, acceleration, height and amplification. These are the hallmarks of great listening.

 

3 Ways Good Leaders Get Conversations Wrong

Blanchard LeaderChat

Male Question Marks Misunderstanding Enigma Men Pop Art Comics RImproving the frequency and quality of conversations that take place inside your organization is one of the best ways to improve the overall quality of your company’s leadership. That’s the message Ken Blanchard and Scott Blanchard share in their latest column for Training Industry Magazine.  With the speed of work, the generational and cultural diversity of the global workforce, and the variety of day-to-day challenges leaders face, the ability to communicate effectively with direct reports may be the defining skill that sets great leaders apart.

And while managers never intend to have unproductive conversations, bad conversational habits can often get in the way of effective communication.  Here are three they recommend that leaders keep an eye on:

Intentionality lapses. Leaders sometimes plunge ahead in an inappropriate setting with negative consequences. For example, you bump into a direct report who has a question, and before you realize it the…

View original post 322 more words

The 10 Commandments of Communication to Build Trust

Blanchard LeaderChat

Ten CommandmentsThe way we communicate with others is a primary way we build trust. Along with specific behaviors and actions, communication serves as the vehicle for building trust in relationships. What we say, how we say it, and how we respond to what others communicate can make or break trust. That’s why it’s important to develop your interpersonal communication skills. There are some basic communication do’s and don’ts…the 10 commandments if you will…that everyone should know to facilitate the growth of trust.

Check yourself against this list to see how many of the 10 Commandments of Communication you adhere to:

1. Thou shalt demonstrate genuine care for the other person – People can see right through a phony. If you don’t genuinely care for the other person in the relationship it will show in your words and actions. If it’s important for you to build trust with someone, then you should find…

View original post 830 more words

What Do Workers Want? Better communication with their leader for starters

Blanchard LeaderChat

Business InterviewEarlier this month, I noticed that a few of my Facebook friends were posting a link to a Wall Street Journal post titled What Do Workers Want from the Boss?

The article describes the results of a Gallup study showing that employees want communication, a trusting relationship, and clear measurement standards from their immediate supervisor.

I messaged some of my friends to learn why they posted the article. They all replied that the findings matched their own experience and they wanted to share. In fact, each of them told me about how a negative experience in one of these areas had resulted in their search for a new place to work.

That’s pretty sad.

The findings identified in the Gallup study are consistent with those uncovered through research by The Ken Blanchard Companies on the subject of Employee Work Passion. We frame these elements as Connectedness with Leader, Feedback, and

View original post 362 more words