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Presentation on Listenting and Speaking for conflict resolution professionals
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- 1. International Ombusman Association 2010 Annual Confere1
- 2. International Ombusman Association 2010 Annual Confere2 HealthCare Ombudsman/Mediators Purpose To serve as an advocate for a fair process for patients, families, clinicians, and the organization, without assuming the role of an advocate for any party.
- 3. International Ombusman Association 2010 Annual Confere3 HealthCare Ombudsman/Mediators Goals Primary: Enhance staff and patient satisfaction and improve patient safety Secondary: Offer alternatives to litigation
- 4. International Ombusman Association 2010 Annual Confere4 Today’s Agenda Setting the Stage - Why Communication Is Important The Good News! Communication is A Skill Barriers Active Listening 6 Steps to Speaking
- 5. International Ombusman Association 2010 Annual Confere5 How to Listen So Your Visitor Will Speak Top Ten Reasons to “Listen” to Today’s Presentation #10 What’s the Big Deal? #9 The Good News! #8 “Doing The Right Thing” The HCOM
- 6. International Ombusman Association 2010 Annual Confere6 How to Listen So Your Visitor Will Speak Top Ten Reasons to “Listen” to Today’s Presentation #7 Cousin Vinny’s Words of Wisdom #6 Active Listening #5 Which Conversation Is It?
- 7. International Ombusman Association 2010 Annual Confere7 How to Listen So Your Visitor Will Speak Top Ten Reasons to “Listen” to Today’s Presentation #4 How to Speak – No Mistake #3 How to Speak – Mistake! Yikes! #2 See It Done Right*
- 8. International Ombusman Association 2010 Annual Confere8 How to Listen So Your Visitor Will Speak The Most Important Reason: #1 What’s in it for you ?? (How you might secure your next promotion!)
- 9. International Ombusman Association 2010 Annual Confere9 How to Listen So Your Visitor Will Speak Two Perspectives – Healthcare Traditional Workforce
- 10. International Ombusman Association 2010 Annual Confere10 How to Listen So Your Visitor Will Speak “There’s been a great deal of emphasis on communication in general in health care…” Vital Smarts President, Joseph Grenny (2006)
- 11. International Ombusman Association 2010 Annual Confere11 How to Listen So Your Visitor Will Speak Setting the Stage – Patient’s Perspective Multiple Providers/Healthcare Delivery Sites Complex Healthcare Environment Heightened Emotional State Fear Broken Trust
- 12. International Ombusman Association 2010 Annual Confere12 How to Listen So Your Visitor Will Speak Setting the Stage -Physician’s Perspective Complex Healthcare Environment Fatigue High Stress
- 13. International Ombusman Association 2010 Annual Confere13 How to Listen So Your Visitor Will Speak Setting the Stage -Employer’s Perspective Fast changing environment Increased Competition Lack of Resources
- 14. International Ombusman Association 2010 Annual Confere14 How to Listen So Your Visitor Will Speak Setting the Stage -Employer’s Perspective Insufficient Notice No Voice Resource Allocation Disagreements Lack of Job Security
- 15. International Ombusman Association 2010 Annual Confere15 How to Listen So Your Visitor Will Speak Setting the Stage – The Organization’s Perspective Ineffective communication costs
- 16. International Ombusman Association 2010 Annual Confere16 How to Listen So Your Visitor Will Speak This same study suggests – Costs to the Organization Loss of time Loss of business Loss of people
- 17. International Ombusman Association 2010 Annual Confere17 How to Listen So Your Visitor Will Speak Costs to the Organization cont: Behavior problems amongst the staff Misunderstandings at all levels Failed Collaboration
- 18. International Ombusman Association 2010 Annual Confere18 How to Listen So Your Visitor Will Speak Costs to The Workforce cont: Mistrust Stress Related Illness Dissatisfaction with the Work
- 19. International Ombusman Association 2010 Annual Confere19 How to Listen So Your Visitor Will Speak What is a leader to do? “As a leader one must have facility in tempting the hearer into that leap of imagination that connects the verbal concept to the hearer’s own experience” Greenleaf (1977)
- 20. International Ombusman Association 2010 Annual Confere20 How to Listen So Your Visitor Will Speak The Good News! “Regardless of personal style, education, or experience, better communication skills can be learned and practiced.” Ron Classen
- 21. International Ombusman Association 2010 Annual Confere21 How to Listen So Your Visitor Will Speak Communication is a Skill~ Reading, Writing, Speaking & Listening can be learned! Requires practice, practice, practice Has universal applications*
- 22. International Ombusman Association 2010 Annual Confere22 How to Listen So Your Visitor Will Speak “Communication lies at the heart of personal interactions...” Ron Classen
- 23. International Ombusman Association 2010 Annual Confere23 How to Listen So Your Visitor Will Speak Why is Communication Important? Benefits Connection Clarity Partnership/Collaboration Creative Problem Solving Openness
- 24. International Ombusman Association 2010 Annual Confere24 How to Listen So Your Visitor Will Speak Barriers External distractions Physical environment Other people
- 25. International Ombusman Association 2010 Annual Confere25 How to Listen So Your Visitor Will Speak Barriers Internal Distracters Physical Psychological Cognitive Emotional
- 26. International Ombusman Association 2010 Annual Confere26 How to Listen So Your Visitor Will Speak Barriers Physical Pain Fatigue Comfort
- 27. International Ombusman Association 2010 Annual Confere27 How to Listen So Your Visitor Will Speak Barriers Psychological Stress Self Absorption Inner Dialogue Anxiety
- 28. International Ombusman Association 2010 Annual Confere28 How to Listen So Your Visitor Will Speak My Cousin Vinny How anxiety and stress may impact our ability to listen… Click on the box to launch the video
- 29. International Ombusman Association 2010 Annual Confere29 How to Listen So Your Visitor Will Speak Barriers Emotional Uncomfortable Feelings Overly Concerned About One’s Well-being Embarrassment
- 30. International Ombusman Association 2010 Annual Confere30 How to Listen So Your Visitor Will Speak Barriers Cognitive Expectations Rebuttal Yes, But Making the Dots
- 31. International Ombusman Association 2010 Annual Confere31 How to Listen So Your Visitor Will Speak How cognitive factors may impact one’s communication…. Notice how this young man reacts to his internal expectations and how he creates the dots. Click on the box to launch the video
- 32. International Ombusman Association 2010 Annual Confere32 How to Listen So Your Visitor Will Speak Listening is about RESPECT “Listening to someone may be the cheapest concession you can make. We all feel a deep need to be understood” William Ury
- 33. International Ombusman Association 2010 Annual Confere33 How to Listen So Your Visitor Will Speak Promoting Listening Space Engagement Eye Contact Body Language Paraphrasing Effective Questions Curiosity Acknowledging Feelings Empathy Gerald Monk, Ph.D & Stacey Sinclair, Ph.D
- 34. International Ombusman Association 2010 Annual Confere34 How to Listen So Your Visitor Will Speak Listening Helps people relax and develop trust Facilitates focus on relevant issues Conveys empathy, respect and acceptance of persons
- 35. International Ombusman Association 2010 Annual Confere35 How to Listen So Your Visitor Will Speak Listening Helps identify and summarize each person’s ideas, perceptions and concerns Leads to a clear statement of problems and issues
- 36. International Ombusman Association 2010 Annual Confere36 How to Listen So Your Visitor Will Speak Listening Intent 3 (listen):1 (speak) Message quality
- 37. International Ombusman Association 2010 Annual Confere37 How to Speak So Your Visitor Will Listen “Good is the enemy of great.” Jim Collins (2001)
- 38. International Ombusman Association 2010 Annual Confere38 Speaking So Others Will Listen Which conversation is it? Meet and greet Information receiving Relationship building Walking the talk Right - right
- 39. International Ombusman Association 2010 Annual Confere39 Speaking So Others Will Listen Which conversation is it? Closing the deal Reporting findings Or Righting a wrong
- 40. International Ombusman Association 2010 Annual Confere40 Speaking So Others Will Listen A 6 step strategy (A.A.L.E.E.) A – anticipate A – adjust L – listen E – empathize E - explain
- 41. International Ombusman Association 2010 Annual Confere41 Speaking So Others Will Listen Anticipate The visitor’s needs Information Emotional support Social connection Reflective listening
- 42. International Ombusman Association 2010 Annual Confere42 Speaking So Others Will Listen Adjust Your communication for Language Culture Nonverbal Timing Pace Depth What vs what and how
- 43. International Ombusman Association 2010 Annual Confere43 Speaking So Others Will Listen Listen How much Understanding Clues Respect Hook up
- 44. International Ombusman Association 2010 Annual Confere44 Speaking So Others Will Listen Empathize Not agreement but recognition Situation Concerns Fears Hopes Anxieties Needs
- 45. International Ombusman Association 2010 Annual Confere45 Speaking So Others Will Listen Explain Only after … Give the other notice Give the information Timely Accurate Sensitive Transparent Complete Take Notice
- 46. International Ombusman Association 2010 Annual Confere46 Speaking So Others Will Listen Recap A.A.L.E.E. A – anticipate A – adjust L – listen E – empathize E – explain Three times
- 47. International Ombusman Association 2010 Annual Confere47 Speaking So Others Will Listen A health care example The conversation is both a Meet and greet And Walk the talk
- 48. International Ombusman Association 2010 Annual Confere48 Speaking So Others Will Listen Note how the doctor: Anticipates Adjusts Listens Empathizes Explains
- 49. International Ombusman Association 2010 Annual Confere49 Speaking So Others Will Listen Health care demonstration of A.A.L.E.E.
- 50. International Ombusman Association 2010 Annual Confere50 Speaking So Others Will Listen What did your inquiry reveal? The wrong thing the right way The right thing the wrong way The right thing the right way Three health care examples
- 51. International Ombusman Association 2010 Annual Confere51 Speaking So Others Will Listen The T.E.A2 .M. Approach T - truth, transparency, teamwork E - empathy A - apology A - accountability M - management
- 52. International Ombusman Association 2010 Annual Confere52 Speaking So Others Will Listen T - truth, transparency, teamwork But first… What How Who
- 53. International Ombusman Association 2010 Annual Confere53 Speaking So Others Will Listen E – Empathize You show before they know Knowing is showing Pinching the pinky toe Platinum not gold
- 54. International Ombusman Association 2010 Annual Confere54 Speaking So Others Will Listen A - Apology Effective apology Who offers
- 55. International Ombusman Association 2010 Annual Confere55 Speaking So Others Will Listen A - Apology * 5 Rs to effective apology Recognition Regret Responsibility Remedy Realignment
- 56. International Ombusman Association 2010 Annual Confere56 Speaking So Others Will Listen A - Accountability Who owns the solution What is the plan Who are the players and what are the roles
- 57. International Ombusman Association 2010 Annual Confere57 Speaking So Others Will Listen M – Management Emotional support Ongoing communication Help in recovery
- 58. International Ombusman Association 2010 Annual Confere58 Speaking So Others Will Listen Recap the T.E.A2 .M. Approach T - truth, transparency, teamwork E - empathy A – apology/accountability M - management
- 59. International Ombusman Association 2010 Annual Confere59 Speaking So Others Will Listen Wrap up Use your tools Determine the conversation Maintain your focus Take care of your self Do good work Stay connected
- 60. International Ombusman Association 2010 Annual Confere60 Speaking So Others Will Listen To understand or explain A – anticipate A – adjust L – listen E – empathize E - explain To right a wrong T - truth, E - empathy A - apology A - accountability M - management Summary
- 61. International Ombusman Association 2010 Annual Confere61 Final Thoughts How does a 6 step strategy have only five steps? 5 steps to becoming good The hidden step From good to great The cost of greatness
- 62. International Ombusman Association 2010 Annual Confere62 Contact Information Susana Garcia susana.j.garcia@kp.org (559) 448-5189 David Richardson david.m.richardson@kp.org (909) 427-7720
- 63. International Ombusman Association 2010 Annual Confere63 References Classen, R., & Reimer, D. (2005). Basic institute in conflict management and mediation. Fresno, California: Fresno Pacific University. Collins, J. (2001). Good to great (1st ed.). New York, NY: HarperCollins Publishers. Fellowship Bible Church. (2005). Get Service. Retrieved July 26, 2008 from www.fbclr.org Greenleaf, R. K. (1977). Servant leadership a journey into the nature of legitimate power and greatness. Ramsey, N.J.: Paulist Press.
- 64. International Ombusman Association 2010 Annual Confere64 References Launer, D. (Producer) & Schiff, P. (Producer). (1992). My Cousin Vinny [Motion picture]. United States: Twentieth Century Fox Home Entertainment, Inc.. Monk, G. & Sinclair, S. (2008). Conflict Resolution and Narrative Mediation for Healthcare Professionals. Emeryville, California: Kaiser Permanente. O’Connell, D. (2008). Communicating Unanticipated Adverse Outcomes with Patients. Oakland, California: Kaiser Permanente. Potter, John W. "Communicating with the Unhappy Refractive IOL Patient." Mastering Refractive IOLs: the Art and Science. Thorofare: SLACK, 2008. 807-810.
- 65. International Ombusman Association 2010 Annual Confere65 References Sales and Marketing Management. (2006, December 22). The cost of poor communication. Retrieved March 16, 2010, from managesmarter.com Ury, W. (1993). Getting past no (1st ed.). New York, New York: Bantram Books. VitalSmarts. (2006, February 8). Silence kills, dialogue heals. Retrieved March 3, 2008, from silencekills.com
Editor's Notes
- Thank you so much for joining us today. My name is Susana Garcia. I am co-presenting today with David Richardson. We are both conflict resolution practitioners – We practice in Northern and Southern California. Today’s presentation is entitled - How to Listen so your Visitor will Speak and Speak so Your Visitor Will Listen. I will begin today’s presentation and then hand it over to David about mid-point. Let’s get started shall we?
- Today’s presentation is comprised of six components – The first section of our agenda is an overview of why communication is important – The cost of ineffective communication is explored Then we will move to the exploration of the premise that communication is a skill – thereby allowing us to become better communicators The third section outlines barriers to effective communication. The fourth section will move us into active listening And then sections five and six will be two fantastic models that if followed, will result in improved communications In this last section we will see a video demonstration of a very well crafted and well delivered difficult conversation between a physician and a newly diagnosed patient who has experienced a delay in diagnosis.
- First I would like to review the Top 10 Reasons why you should listen to our presentation today - Reason #10 – What’s the Big Deal anyway?! We have interesting information that points to the importance of effective communication in today’s workplace. We will share these findings with you. Reason #9 - Effective communication does not always come naturally to us. The Good News……effective communication is a skill and can be learned – we will tell you more throughout this presentation. Reason #8 – There are a group of 28 conflict resolution practitioners who aspire to always “Do The Right Thing” - They are a group of Healthcare Ombudsman/Mediators of which David and I are a part of - Both David and I currently serve as HCOMS within a large integrated health care delivery model known as Kaiser Permanente. I’ll describe the position a little bit more later in the presentation.
- Reason #7 – My Cousin Vinny has a lot to contribute to our presentation – we will see how we can learn from him…. Reason #6 – There are characteristics of active listening that one can model as one begins to sharpen their skills – we will share these characteristics with you Reason #5 – Did you know that there are different types of conversations – I bet you did! We will help you determine which type of conversation you need to engage in and how to best craft the message – now that’s important stuff!
- Reason #4 – We will share a communication model that will help you craft a message that does not involve the disclosure of a mistake – those are the easiest More interestingly, Reason #3 – We will share a communication model that will help you craft a message that DOES involve the disclosure of a mistake! Yikes! And Reason #2 – we will show you a perfectly crafted conversation that involves key characteristics of an excellent communication model
- And Reason #1 is…… What’s in it for you??? Although I hope that reasons 1 thru 9 enticed you to stay for our presentation – there is a monumental reward for you personally. We all know how tumultuous our current economic environment is right now - naturally this leads to a bit of concern around job security. Well, after hearing today’s presentation you will be able to identify, recommend and begin to prepare and even deliver a skill-building opportunity to your organization around the most important workplace skill today! Stay tuned for more!!!
- Before we explore the intricacies of this work, let me set the stage in two different arenas: One in healthcare and the other, the traditional workforce environment Two Perspectives – Healthcare – HCOM description Traditional Workforce – organizational Ombuds
- “There’s been a great deal of emphasis on communication in general in health care… but unless and until health care workers learn to step up to these specific crucial conversations, they will fall far short of their potential for delivering high quality care” Vital Smarts President, Joseph Grenny (2006)
- In a patient’s perspective major challenges to communication include receiving care from multiple providers. Healthcare can be fragmented – communication between providers can be compromised. This causes great frustration for the patient who is receiving multiple and sometimes contradictory messages. Add to that The complex system that healthcare is and the challenge becomes very real. Although healthcare is usually managed by one’s primary care physician, if one is in need of specialty care and ancillary services, the care becomes quite confusing and complex. This of course leads to a heightened emotional state. An illness surfaces many emotions. When one considers the multiple messages within a complex care system, emotions run high. It is times like these that communication becomes paramount. When you compound the scenario with an unanticipated adverse outcome fear sets in, and all the other negative emotions/reactions that come from broken trust. Healthcare ranks as one of the most personal and critical services that one seeks throughout their life. In large part, the quality of the service is based on trust and respect. When an adverse outcome occurs trust is broken and disappointment sets in – Studies prove that immediate resolution is the key to restoration and healing. As you can see from the patient’s perspective communication is paramount.
- In regards to the provider’s perspective. Many stressors exist within the healthcare provider’s world as well. Physicians and providers work in an extremely complex healthcare environment. They have to deal with - A Highly Regulated Environment including Multiple Licensing Agencies The Rise of Malpractice Costs Legal Implications/Limitations including Medical Malpractice The High Cost of Delivering Care Rapid Advancement in Medical Technology Differences Between Eastern & Western Medical Care Cultural Differences, Diversity & Literacy Working in this type of complex environment day in and day out can lead to fatigue and high stress Certainly clear communication is paramount to healthcare providers.
- A study by Information Mapping, Inc. (IMI) suggests ineffective communication, everything from poorly written e-mails to outdated documents, costs a company in time, money and reputation.
- And the the list continues – Studies prove that Mistrust begins to flourish within the organization which can result in stress related illnesses and injuries And dissatisfaction with work. Clearly, one can build the case that an organization in its entirety is impacted by poor communication channels (interpersonal and systematic channels as well)
- With all of these issues in mind, what is a leader to do in today’s modern world. An eminent writer, consultant, and lecturer Robert Greenleaf. Back in 1977 he stated – “As a leader one must have facility in tempting the hearer into that leap of imagination that connects the verbal concept to the hearer’s own experience” Of course to do so effectively requires a unique skill known as effective communication.
- “Communication lies at the heart of personal interactions…, whether in family, friendships, the workplace, the public sphere, or in any other of the many arenas in which people engage one another.” Ron Classen
- I would like for each of us to think back to our last major disagreement with our Significant Other or Sibling, Parent or Friend. If we take an honest assessment, I believe we would all agree that poor communication was a key ingredient in the disastrous recipe. Our history proves the same – you may recall hearing about the airplane that went down in the Potamac River because the pilot failed to hear the co-pilots warning of ice and snow buildup on the wings of the airplane. The accident was tragic – many people lost their lives.. Evidence of the importance of effective communication is in all the literature – both effective listening and speaking skills are important. There are many benefits to communication. For example, effective communication allows us to connect with another person on a deeper level. issues are better clarified and in turn, ideally better understood by the listener one has a better chance of developing partnerships if communication is effective creative problem solving is a result of effective communication and effective communication encourages openness and transparency
- One of the key points we must consider when we engage in communication are external distractions. The physical environment can prove to be quite a barrier. For example, One would not want to engage in a difficult conversation in the middle of a construction site or a busy emergency room. Noise, equipment, the physical setting all play a major role when one attempts to create an environment conducive to good communication. Another external distraction one must consider is the impact of other people in the near vicinity. A screaming toddler can quite easily distract one from the conversation at hand. In contrast, a calm and engaged third party may add an element of safety and reason to the conversation at hand.
- Additionally internal distractors may pose as barriers to the involved parties. There are various internal distractors – namely, physical, psychological, cognitive and emotional.
- In regards to physical distractors, our physical being impacts our ability to concentrate and respond appropriately. Even under the best of circumstances if one is distracted by any physical ailments, one’s ability to engage in an effective communication exchange is compromised. For example, consider a communication with a patient who just underwent surgery. As an HCOM it is quite common that we interact with patients/families soon after a procedure. Because of the very nature of the procedure (especially invasive ones) or maybe because of pain medications given post-operatively the patient may be experiencing some pain, fatigue, discomfort and certainly uneasiness. Trying to engage a member during this time of physical discomfort will not result in an effective exchange of information. In fact, to expect so would be unrealistic and unacceptable. And finally, at times we are in a state of urgency. When one is being rushed out the door or is faced with an on-coming ambulance with a siren blaring one does not have the ability to compartmentalize the urgent event and continue with a meaningful communication. In fact, many times when one is in a state of urgency the fight or flight response kicks in. Certainly, meaningful conversations are not likely in these situations.
- And now let’s move on to psychological barriers. There are various psychological issues that impact the quality of communication. These again, are internal distractions. Feelings about the other, stress, self-absorption, apathy, inner dialogue and anxiety all play a part when one engages in communication with another. If one has had negative encounters in the past with this person that have resulted in negative feelings, one is less likely to want to engage in a communication with the other. One’s shadows and projections play a part here - High levels of stress and self-absorption also prevent one from connecting. For example, if one just received a phone call from your child’s school that your child just had an accident he/she will certainly not be able to engage in a conversation in any meaningful way. And finally a constant inner dialogue and/or anxiety prevent one from focusing on the conversation at hand and fully engaging. Psychological barriers are real and they significantly impact communications.
- Clearly one can see how My Cousin Vinny’ psychological state impacted his inability to hear his girl friend’s biological clock: The stress and anxiety he was feeling was simply overwhelming!
- Another type of distractors falls in the emotional category. Uncomfortable feelings, lack of well-being and embarassment are examples of emotional challenges. When one of the parties is overwhelmed with uncomfortable feelings they lose a sense of safety. In turn, communication is compromised. If one is concerned about their current and future well-being, communication is compromised. And finally, embarassment. When one is badly embarassed, immediate withdrawal from the situation can occur.
- One of the most difficult conversations in the healthcare setting involve parties with cognitive distractors. Cognitive distractors negatively impact communication. For example, if one of the parties engaged experiences difficulty with their memory, judgment, and/or reasoning, communication is significantly impacted and many times, will breakdown simply because the parties fundamentally disagree. Common cognitive issues include Expectations – Unrealistic expectations Rebuttal – One is focused on the next rebuttal instead of focusing on the conversation at hand Yes, But – One’s tendency is to shoot the person down no matter what they are saying poses a barrier Connecting the Dots not Making the Dots – If one is busy trying to make the dots instead of connecting them appropriately one misses the opportunity to truly listen and communicate
- Clearly this young man’s perspective was impacted by his preconceived expectations and inability to connect the dots until his perspective changed. The good news is that although there are many barriers to effective communication there is an inherent desire in each of us to be understood. This is what keeps communication flowing. As renowned author and educator William Ury stated, “listening to someone may be the cheapest concession you can make. We all feel a deep need to be understood” – this puts us all on the same playing field don’t you think?
- Now that we can consider that we all want to be heard, let’s see how we can become better listeners – Dr. Monk and Dr. Sinclair have outlined important components to effectively listening – Five of these components are here - Some of these components may be familiar to you. The first is Space – You want to assure that you create the right space for the conversation - does your partner know that you are engaged, are you maintaining appropriate eye contact and are you using the right body language? Paraphrasing As your partner is speaking periodically paraphrase their comments to clarify and confirm Ask effective questions and more importantly – stay in a state of Curiosity By asking effective questions and remaining curious, your communication partner has an opportunity to fully explain their point and consider that there may be an alternate story Acknowledge feelings As your partner is sharing their story, acknowledge their feelings. By detaching yourself from their story they have the ability to open themselves up to you and essentially unload all the emotional baggage they are carrying – what a sense of relief for them! Empathy As you listen, remain curious and empathetic – “No one cares how much you know until they know how much you care” - if the speaker knows you care they, communication will be improved immensely.
- These listening techniques will Helps people relax and develop trust Facilitates focus on relevant issues Conveys empathy, respect and acceptance of persons
- Additionally, these techniques will Help identify and summarize each person’s ideas, perceptions and concerns Lead to a clear statement of problems and issues
- Now let’s consider other promoters of communication. One primary promotor is one’s intent. One can be highly motivated if one is intent on reaching a desired outcome or goal. It is common knowledge amongst HCOM’s that one’s intent is critical to the management of difficult conversations. Other promotors – non-verbal A good rule of thumb to follow is that one should listen three times longer than one speaks. To be an effective communicator one must give the other party an opportunity to express themselves fully and without interruption. Another consideration is the richness of the communication – the quality of communication impacts the quality of the message. For example – music on a sheet of paper is quite different from the music you will hear on a CD vs the experience you will viewing a concert video – all communicate the same song but the quality of the message interpreted by the listener is vastly different. The secret is to choose the appropriate message for the receiver.
- That concludes my section of this presentation – I would now like to turn the presentation over to my colleague David as he helps us take it up a notch with very rich skill building information - Let’s see how we can go as one of my favorite authors says ->>> from Good to Great!
- When it comes to speaking so your visitor can listen the first decision you have to make is which conversation are you preparing to have? Is it the Meet and greet, walking the talk, or closing the deal? Because the needs of the visitor, and his or her internal obstacles to listening are likely to be different. Meet and Greet This is the initial conversation between you and the visitor. It’s like a blind date. You are each feeling the other out and getting to know each other on one level. Simultaneously, you are gleaning information contained in the visitor’s narrative. Your effective listening produces two results, 1) you derive meaning from the narrative from the words, tone of voice and the gestures used. 2) you develop a therapeutic connection with the visitor that allows you to work together through a difficult situation. By the way there isn’t just one narrative, it is an evolving and dynamic story that is unfolding before you. Every time the visitor tell his or her story it changes a little based on the feedback the audience offers. So that the story you are hearing may not be the same story your visitor told to others and may not be the same story he tells you next time. Try to convey your openness and lack of evaluation of the story. The meet and greet may be performed multiple times until you and the visitor agree you have a shared understanding of the story. Walking the Talk – Once you have looked into the visitor’s concerns and are prepared to share your findings you are having the this conversation. You may still be in the process of gathering information and are simply sharing your up to the minute findings but are not at the point of a resolution yet. AALEE is the key to having either the Meet and Greet or walking the talk conversations. If you are simply reporting your findings and there is no wrong that needs to be righted such as when you reporting back the applicable policy related to the issue of concern then use AALEE
- When you are closing the deal you are bringing closure to the Ombudsman – visitor interaction. You have concluded you inquiries and are now prepared to share your findings. The question now becomes was there an wrong doing that needs to be addressed? If the answer is no then you can use the 6 step strategy using AALEE. If on the other hand “they” admit to an error either because the wrong thing was done or the right thing was done the wrong way then use the TEAAM method. Each of these methods will enable you to connect with your visitor at an emotional level so that your visitor is prepared to listen to and act on your message.
- TEACHER TIP:THE ALEE MODEL IS FOR SITUATIONS WHERE YOU ARE EITHER SURE THAT THE ACTIONS WERE REASONABLE OR WHEN FURTHER INVESTIGATION WILL BE NEEDED TO DETERMINE what has happened and how, BUT AN INITIAL DISCUSSION PROCESS MUST BE INITIATED. “Let’s start with the ALEE model that we can use when there has been an adverse event or outcome and we either believe that the action was reasonable or we need to do more investigation before we can confidently address questions of responsibility.
- Start by anticipating the thoughts and emotions that the visitor is likely to be experiencing. Pay attention to your own thoughts and feelings as they may reveal where you feel most vulnerable. Your own emotions can shape your response if they are unexamined before the conversation. Begin the conversation by expressing sympathy for their experience. “I am sorry that you are experiencing this disappointment.” If there is a clear explanation for the adverse event that indicates the evaluation was fair, then your must still anticipate how the situation may appear from the visitor's perspective. You should also anticipate whether additional exploration will be necessary before a reasonable explanation can be offered. This will remind you to avoid pressure to conjecture about possible causation but instead to promise an examination of the facts with follow-up discussion as soon as possible.
- It is likely that you will need to adjust your approach in light of the visitor’s adverse experience, what adjustments are you willing to make in light of your anticipation of the visitor’s possible concerns and questions.
- Listening to the other person’s perspective gives your visitor a chance to ventilate their upset and tell their story. They will often tell you what questions and concerns are most troubling to them and must be addressed. There are benefits to your listening effectively to your visitor, your listening will enable him or her to speak so that you both understand the issues of importance How much is enough The Proper Ratio Susana suggests the ratio might be 3:1, that is you are listening far more than you are speaking For understanding Provides Information To get a clue Gives Access to Subtle Clues into the thoughts and feelings of the visitor Respectfully - Demonstrates Respect To hook up - Fosters Connection
- Empathy is different from agreement. We must recognize the full impact of the harm that has been caused (medical, emotional, practical, financial) in the visitor’s own language, a language that he or she might easily understand. You are striving to understand their upset because you must acknowledge this empathically if working rapport is to be established. Remember, the visitor is not really angry at you personally. He/she is angry at the role you fill in the experience. They are angry at the manager who wrote the evaluation. With this bit of compassionate detachment, it will be easier for you to empathize rather than defend yourself. You might say something like “I can understand why you would you be upset and wondering if this was a fair evaluation.” without feeling personally accused of being unfair.
- Defending yourself or others actions will likely sound self-serving. Explanations are best received by those who are ready to hear them. Asking if an explanation would help before launching into an explanation that might miss the point or sound defensive can frame the discussion as driven toward mutual understanding rather than sounding defensive or argumentative.” If you have followed the preceding four steps you are in the best position for the explanation to be heard in the manner you intended. Give the other notice Begin the explanation by preparing the other person for what is about to happen. It is very likely that the other person is not expecting what you are about to say. She may have been anticipating or hoping for just the opposite of what you have to explain. So give him/her time to prepare by saying something like, “I have an answer to your question that is not the answer you had hoped it would be.” Give the information Now that you have prepared the other person by giving him notice the important news or message is coming its time to deliver. Being sensitive to the other person’s emotional or psychological state give all the pertinent information you have, the complete story. When you have delivered the accurate, timely and sensitive truth pause. Allow her to experience, acknowledge and respond. Take Notice The final step in the explanation is for you to pay attention to the feedback from the other. Were there words or concepts that seem to evoke more of a reaction than others? Did some things seem to need explanation or clarification? Check in and see what was heard? “Can you tell me what you understand from what I just said about…. Might be a way to elicit which message was heard and is being processed.
- Remember that AALEE is used for the first conversation to share information with the visitor because you aren’t sure which track the issue will take and for periodic updates Or because you have looked into the visitor's concerns and there is no wrong to be righted only actions or policy to be explained or described.
- “Let’s bring the situation in the room for us to experience. In this video demonstration Dr. Pedrosa uses AALEE to listen to her patient’s concerns and speak with him in a way that allows her message to be heard by the patient “ While this particular example is in health care the skill used is universal and can be adapted in order environments Case Background: PARAPHRASE FOR PARTICIPANTS Scenario #1 - Lung Mass Mr. Akada is a 60-year old gentleman who first presented to his primary care physician 4 months ago with complaints of shoulder pain. He was initially diagnosed and conservatively treated for a muscle or ligament strain. His pain persisted and he was subsequently referred to orthopedics. X-ray revealed nothing remarkable and he was referred on to PT/physiotherapy. 2 months of PT were without benefit. Sent back to ortho, another shoulder x-ray still reveals no surgical problem. He is given steroid injection in ortho and given follow-up appt for 2 months. One month later however, he develops cough, fever and shortness of breath and is directed to the ED (Emergency Department). When x-ray over-read by radiologist hours later she reports suspicion of a lung mass in difficult to visualize lung fields. Recommends follow up film in 1-month and a consult with a lung specialist. PCP sees Mr. Akada in ED follow-up visit, has read radiology report and tells patient to have repeat film in 3 weeks and arranges a pulmonary consult. PCP does not tell Mr. Akada about possibility of lung mass out of concern for “not worrying him perhaps unnecessarily”. Video is re-enactment of first visit with Dr. Pedrossa the lung specialist, she will now try to use the ALEE model in connecting with Mr. Akada and providing him a plan of care.
- Note how the doctor: Anticipates and Adjusts her speaking and listening Listens without rushing or interrupting Empathizes by words, voice tone, body language Explains and address questions
- (5:23 video) LUNG MASS (DR. PEDROSA)] DEBRIEF WHAT PARTICIPANTS OBSERVED. Teaching Points Try to involve many participants. Use the participant response sheet as a guide for facilitating discussion. Take them through each of the ALEE elements and ask for observations. Dr. Pedrossa adjusts her usual consult routine to ask her MA to keep the patient dressed while she reviews the recent x-rays which is an adjustment in light of her anticipating the patient’s reaction. She listens carefully, never talking over the patient or appearing in a hurry even thought the whole conversation takes less than 7 minutes. She adjusts her language and pace of speech to take into account his understanding and confusion. She is empathic in voice tone, body language and the words she uses. Ask for evidence of this. She gives an explanation in answer to the patient’s question. “All these doctors and x-rays never made them think of that?” Isn’t he asking the question “What track are we on here? With error or without?” Her explanation points out the limitations of medical science in that we make diagnoses based on probabilities. Without breathing symptoms, family practice doctors and orthopedists would not be expected to go looking for lung masses, although in hindsight this now looks much more possible than it did before the pneumonia.
- Let’s look at the conversation you might have after you have completed your inquires and either the wrong thing was done to the visitor or the it was the right result but done in the wrong way. So now there is a wrong to be righted. It’s true the visitor was given a performance evaluation that was less than she deserved based on the supervisor’s statements, (“yes, I should have rated her higher than I did. That evaluation was not accurate.”) Or maybe the poor performance evaluation was deserved but it was not given in private. In both of these situations the TEAAM approach to communication is the superior choice because it literally involves as TEAAM of people doing the right thing to improve communication and strengthen the relationships.
- Here we summarize what the literature and experience tells us must be addressed as we attempt to work through an adverse outcome that was caused in whole or in part by human or systems errors or significant deviations from policy. Note that we are only on this track if we have thoroughly looked into the situation the results of which has led us to this conclusion, e.g. there is a wrong to be righted. This is not a conclusion we come to impulsively. First we know that visitors want the truth, the actual facts of their situation its implications. They look for us to be transparent, not hiding things or spinning things, or avoiding tough questions. This is rarely the work for a single individual. It usually takes a TEAAM of people to investigate, to come to reasoned conclusion about causes and effects, and to work the situation through for the visitor and addressing all the fallout/implications of what has happened.
- Before you begin the telling remember what we did to prepare the other person when we had news to when there was no wrong to right? Put the other person on Notice that something important is coming, give the other Knowledge then take Notice to the reaction and adjust as necessary. A mama might say speak the truth in love that is laying it out as it is without regard for the cost. Telling everything you know about the situation, who did what when, how and for what reason. Being transparent is different from being translucent or opaque. Not being afraid to say, ‘I don’t know”. It’s also helping others to have the courage to admit mistakes – so you might become an advocate for a cultural change in your organization so that mistakes and errors are viewed as opportunities for growth, we might come to realize errors more about bad systems than about bad people.
- You show before they know - Your visitor will not be interested in what you have to say until he is certain you understand what he is going through so speak to that with congruent language and non-verbal communication. Make sure your words are congruent with your actions large and small Knowing is showing – Empathy has to be demonstrated, use your words and nonverbal communication to convey, ‘I understand what its like for you in this moment’ Whose shoes are these – when you place your self in those shoes what does she feel? What are your thoughts? What are your fears? You are a poor surrogate – at best this is a guess, it is a poor approximation of what the other is feeling but it’s a start use this information along with what your visitor actually says and the nonverbal communication he or she is using. What does the golden rule tell us? Do to other people the same things you want done to you . What’s the problem with the golden rule? It places you at the center, you and your needs, fears, feelings become the focus. The platinum rule on the other hand places your visitor rightfully at the center of the situation. Instead of asking how do I want to be treated, you ask, based on this set of circumstances what is it that she needs or wants? This places focus in the right place.
- People who have been hurt or humiliated often hope for an apology. They may hope that an apology from the person who caused them harm will restore dignity, trust, and a sense of justice. Whether you are requesting an apology or considering giving one, it is important to realize that a thoughtful apology can mend a relationship while a thoughtless one may cause further conflict. Why apologize? An apology can often be the first step to better understanding in a damaged relationship. It says that you share values regarding appropriate behavior towards each other, that you have regrets when you don’t behave according to those values (intentionally or unintentionally), and that you will make greater efforts to live up to your shared standards of behavior. Timing can be crucial. An apology delayed may be an opportunity lost. Why not apologize? If an apology does not feel sincere, it can further damage the relationship. Sincerity is expressed by what you say, how you say it, and what body language you use. If you can’t include all the elements of an effective apology, it may be best not to apologize. An inadequate or insincere apology can feel dismissive to the offended party and may heighten conflict. Who owns it – is there a specific person responsible for resolving the matter? Who is going to offer the apology? Under what circumstances
- Recognition first of the wrong doing and secondly of the need for an apology. The offending person will need to recognize the effect of his or her actions on the aggrieved party. And a recognition that their pain or embarrassment was legitimate, even if others might have felt differently. A specific definition of the perceived offense. The person offended and the perceived offender need a clear shared understanding of the behaviors (or omissions) that felt hurtful, rude, or wrong and a commitment not to repeat them. A statement of regret. While “I’m sorry” is not enough for a complete apology, it is a necessary part of any apology and is imperative for re-building trust. The idea is to convey a Desire to make other choices or achieve other results. Taking responsibility. Apologizers should acknowledge that, whether or not the offense was intentional, they hold themselves accountable for the harm. A Remedy for the situation expressed as A promise not to repeat the offense. Here is where you would offer a clear plan for self-restraint, improved behavior, and how to work with the offended person to address possible future misunderstandings. Realignment is about using the present situation to inform and transform others so that they will not make the same mistake, cause the same harm, offend in the same way
- Who needs to be a part of the conversation? Who needs to be at the table? Is this a mediated or negotiated resolution ? Is the table even or do some sit higher or lower than others Who owns what? Is there a time table for the corrective action, what are the contingencies
- M – Manage On going Emotional support for all parties involved in the situation and implementation of the solution Continuing to serve as an Ongoing communication facilitator as needed Help in recovery w/o advocacy the ownership for correcting the wrong must be on the shoulders of the management not the Ombudsman Your value might be in helping the parties to discover solutions, reframing, clarifying the issues, identifying there interests whether the needs are practical, financial
- Use the TEAAM approach when either the wrong thing has been done to the visitor or the right thing was done the wrong way The focus of the TEAAM approach is rebuilding of trust and restoration of the relationship, it’s making things right according to the parties involved in the conflict
- Use your tools Determine the conversation Maintain your focus Take care of your self Do good work Stay connected
- How does a 6 step strategy have only five steps? There is a little know and often unspoken hidden 6th step. This step is somewhat controversial and is not suggested for everyone to use. If you use the 5 steps described in the AALEE and TEAAM mnemonics they will make you a good communicator for your visitor But the little known 6th step will move you from good to being great The 6th step in our speaking algorithm is your whole self. That means not only bringing your intellectual and logical self to the conversation, we already to some degree remember that. Beyond your psychological self which is the sum of your experiences, biases, predilections, wishes culture and fears the 6th step talker brings the speaker’s emotional responsive self to the conversation. Here’s what I mean by bringing your emotional self to the conversation. Your visitor says something amusing, would you hesitate to smile? She says something funny do you laugh with her. He tells you something shocking do you react as if you have been shocked? That is how you might respond in the context of another human interaction, as a whole person with emotions and everything. The essence of the 6th step is being real, genuine, authentic, your whole, best, true self. Why shouldn’t you be amused, shocked, touched by the stories you hear and the distress you see before you? You may have heard that you need to maintain a professional distance. That caring and responding will impede your ability to do your job. You must remain dispassionate in order to remain neutral. I submit to you that being neutral is more about deciding who is right and who is wrong and not about understanding from an emotional vantage point your visitor’s experience. Walking in some one else’s shoes mean you feel the same rocks and walk in the same fur roughs. As you might imagine the 6th step is not cheap and it will cost you something to be able to access and harness its powerful benefits What is that cost you ask? You will not be able to identify with your visitor’s suffering without caring about your visitor, and you will not be able to care about your visitor without investing some of your emotional currency into understanding the perspective of that other person. That investment is a cost to you. You have to know that up front. For you the cost may not be worth the payout. That is a personal and appropriate decision just like genuine emotional response is an appropriate choice they are both yours to make.