By combining understanding of what motivates people with well-crafted language, it is possible to increase your influence and achieve your aims without anger, frustration or stress.
We are often told not to judge someone until we have "walked a mile in his or her shoes." Most writers attribute this saying to a Native American proverb, but wherever it came from, it is certainly in common use and few would argue its wisdom.
Seeing things from someone else's perspective, however, can be one of the most difficult things to do, and can be particularly difficult for physicians. After all, we spend an entire lifetime developing and defending our own view of the world. Our training and temperament focus our attention on self-reliance and a healthy skepticism of the opinions of others. Sometimes that ugly pair of Size 8 boots is the last thing we want to put on our Size 10 feet.
Physician leaders must function in a world that is much less hierarchical than clinical medicine; one in which we encounter many people who are highly intelligent and dedicated, with or without commensurate credentials. In that world, we are not called upon so much to give orders, as to work with others as part of a team.
To do this successfully, it is necessary to be able to hear opinions objectively, put aside any frustration or other negativity we may feel, and express ourselves in a way that demonstrates understanding and compassion for another's point of view. There is no place for intolerance or condescension.
Although each individual and situation we encounter is unique, here are four places to look when you are trying to understand what is motivating your colleagues, subordinates, and even the CEO:
People act to gain pleasure and avoid pain. As I go through a clinical workday, I always try to complete all the documentation for a case by the time the patient is dropped off in the post-anesthesia care unit. It's not that I'm trying to win awards from the medical records folks; it's just that after a long day in the operating room I find it painful to have to sit and finish the paperwork. I'm much happier doing it in real time.
Seeking pleasure and avoiding pain lie at the most basic level of everything that motivates us. We are born with primitive reflexes that are designed to meet our needs. As they fade away, they are replaced with more complex and subtle strategies for winning approval, quieting anxiety and avoiding hurt. Higher brain functions replace innate reflexes.
Moments of frustration can trigger a need to be heard and produce an unproductive angry outburst that we regret later.
This doesn't mean, of course, that there is a whole lot of reasoning going into the process. We may learn that we are rewarded with attention and approval for certain things such as athletic accomplishments or academic achievements. Maybe we are rewarded with love and attention for eating well or admonished to clean our plate. Like Pavlov's dogs, over time we develop a set of associations among various behaviors, pleasure and pain.
In his book, Awaken the Giant Within, Tony Robbins talks at length about pain and pleasure. In fact, he tells us that the things we link to pain and pleasure determine our destiny. If you are a physician, it is because you link pleasure to such things as academic achievement, scientific thought and caring for others. Someone who links pain to school and dislikes math and science is unlikely to pursue a medical career.
People act in the service of their values. I am a doctor. I am schooled in science and tend to believe there is one true and objective solution to a clinical problem. I value the truth and my ability to recognize it, along with autonomy, hard work and dedication. These are values that make us great doctors. Unfortunately, they can sometimes get us into trouble outside the clinical arena.
Others around us may have different priorities. Nurses, for example, are taught to follow procedures and protocols. Sometimes we disregard protocol when we think it is in the patient's best interest; the nurse who questions us is acting in service to her values and means no disrespect.
Administrators tend to value collaboration more than we do and, in their world, there can be many valid approaches to the same problem. If you defend your position by insisting that it is the only true answer to an issue, you are unlikely to be persuasive. Savvy physician leaders understand the values of those around them and are able to demonstrate an alignment between their own goals and those values.
The idea that people act in service to their values doesn't necessarily mean that people are selfish. Sure, if your highest value is your own benefit, you'll end up acting accordingly. On the other hand, if you value your family, country or patients above yourself, you may act in a way that serves those values but ultimately brings you to sacrifice something. This is what keeps physicians working 24 to 36 hours at a time. Someone needs us, and we place great value on being available to help.
People act to get something they need. One of the important concepts in coaching is the idea of integrity. While we commonly think of integrity as being aligned with some well-defined moral standard, coaches use the term a little more subjectively. If we act in accordance with our values, we are acting with integrity; we become out of integrity when we act in a way that is contrary to our values.
Generally, we find ourselves out of integrity when we have an unmet need. One of the perils of substance addiction is the persistent imperative to meet the need for alcohol or drugs. This can lead to deceit, criminal activity or a host of other maladaptive behaviors. The need for attention and approval can lead to sexual addictions, feelings of helplessness and eating disorders.
On a more functional level, acting in a manner that is “out of character” or “out of control” is almost surely due to an unmet need. Moments of frustration can trigger a need to be heard and produce an unproductive angry outburst that we regret later. Our news reports are full of stories of powerful people stepping away from their integrity and becoming involved in career-damaging scandals. These are motivated by unmet needs, getting the best of values and even self-interest.
One of the more common places that physician leaders may run into unmet needs is in negotiations. The negotiator opposite you has an agenda of which you are likely only partially aware; and it involves needs. Negotiators need to please their partners, bosses, clients and shareholders. Understand what your opponent needs to get out of the negotiation, and you will understand where your bottom line offer lies. In their seminal work, Getting to Yes: Negotiating Agreement Without Giving In, Roger Fisher and his co-authors tell us "the basic problem in a negotiation lies not in conflicting positions, but in the conflict between each side's needs, desires, concerns and fears."
People act according to how the world occurs to them. This is what trips most of us up. Life occurs to us differently depending on whether we are men or women, baby boomers or millennials, Republicans or Democrats. The greater the cultural or age differences, the harder it is to see things from the other's point of view.
Getting to someone else's perspective requires us to move outside our comfort zone and involves the very real risk that once we have seen an issue from another side we may be persuaded to change our stance. Depending on the issue, our self-image may even be changed; this is risky stuff, indeed.
Steve Zaffron and Dave Logan discuss this at length in their book, The Three Laws of Performance. In fact, the first law is: “How people perform correlates to how situations occur to them.” These authors see it as the answer to the question, “Why do people do what they do?”
They then go on to discuss the power of language. As physicians, we place great importance on having the correct answer and doing the right things — lives, after all, depend on that. We tend to pay much less attention to the words we use as long as they in some way convey the truth.
Attorneys, on the other hand, have a very different view of the power of words. They understand that truth is a phenomenon of both perception and understanding and that understanding is closely aligned with the words that are used.
They know how to apply Zaffron and Logan's second law: “How a situation occurs arises in language.” Could you ever imagine an attorney allowing himself or herself to be referred to as a “legal care provider?” Does the way you think things should be done occur as dangerous, neutral or aligned with the needs and values of those around you? The key to understanding and being understood lies in language.
Actively Pursuing Understanding
As payment models develop in the wake of the Affordable Care Act, the one thing that seems certain is that we are going to become increasingly dependent on each other; our goal in any interaction is to find a common ground of communication.
This not only benefits our practices, multispecialty groups, hospitals and health systems; it also leads to our own growth, an increasingly favorable reputation, and ultimately, the expansion of our overall influence. The keys to understanding are listening and questioning. Understanding and language are, in turn, the keys to being understood.
As stated in Getting to Yes, “the challenge is not to eliminate conflict but to transform it. It is to change the way we deal with our differences — from destructive, adversarial battling to hard-headed, side-by-side problem-solving.”
To understand, we must develop the skill of listening, which is much more than simply hearing. The Coach U training books promote a curriculum that teaches that “hearing is a sensory ability. Listening is a skill. … As you learn to listen more effectively and deeply … you will become a source of value.”
You become a source of value because few people are able to listen skillfully. It is important to listen to understand, not to figure out what to say next. Pay attention to more than the words. Listen for tone, for volume, for mood and speed. Listen to what is not being said as well as to what is said.
Be aware of any reasons you might be rushing to judgment and avoid drawing conclusions prematurely; that is of little value to you or the speaker. Pleasure and pain, needs and values, are expressed if we only listen with all our senses and presence. The words used by the speaker are rich with information as to how the speaker views the world, himself and you. Listen as you might to a piece of music.
Even when one party is making an earnest attempt to communicate and the other an earnest attempt to listen, difficulties can arise because of differences in culture, age, upbringing and goals. Good questions are crafted to bring you the answers you really want and are essential to bridging these differences.
Your questions should never be accusatory or judgmental or you will harm rather than enhance your opportunity for understanding. Good questions also allow you to control the tempo and direction of the conversation. They provide both parties with an opportunity for discovery and growth.
Good questioning builds on, but doesn't replace, good listening; it is always secondary to and augments listening. Don't sacrifice the opportunity to hear something important because you were busy formulating a question.
If we have listened well and filled in the gaps with good questions, we have come to know something of the other's central self. In The Art of Possibility, co-authors Rosamund and Benjamin Zander talk about the central self — the consistent nature of who we really are. They also discuss the calculating self — the persona we adopt beginning in childhood because it seems to help us make our way in the world.
In any meaningful conversation, it is important to understand and speak from and to the central self; careful listening enables that to occur. Addressing ourselves to core needs and values, we arrive at mutually beneficial solutions.
Mutual understanding is greatly facilitated by mutual language. Listen for words, tempo and phrasing. You don't want to parrot what someone else is telling you, of course, but do find words that you have in common and that you can comfortably use.
Listen for words and phrases that the other party uses often and try them on for size in your own speech. Always be aware that words have power. The language we use gives others powerful clues as to who we are, what we think of them and what we want.
According to Coach U, the three essential elements of language are word choice, alignment and delivery. Word choice includes not only single words, but also phrasing, storytelling, and the use of metaphor. Alignment is the use of the other person's jargon, definitions, stories and emotional state to craft your statements and questions. Delivery involves things like volume, pace, timing and facial expressions.
Make sure that the impression you give is the one you want and that your message is clear. Understanding of the other person and skillful use of language allow you to be understood.
The behavior of others need not perplex and frustrate us. By keeping in mind the four areas from which motivation arises and using skillful listening and questioning, we can come to a satisfying depth of understanding. By combining that understanding with well-crafted language, it is possible to increase our influence and achieve our aims without anger, frustration or stress.
Chris Cantilena, MD, MMM, is an anesthesiologist and a personal, career, and business coach for health care professionals based in Southern California.