Changing behaviors…made easier

As physicians, we are the leaders of the healthcare team. And with medicine becoming more specialized, we depend increasingly on employees and consultants for their contributions. Unfortunately, it often seems that their vision doesn’t match ours and their behavior reflects it. We wonder why they don’t do what seems so obvious to us. If only there were a way to clearly and effectively tell people what we really need from them. I have tried wishing, hinting, modeling, and sticking my head in the sand.
Sorry to report this, but none of those strategies worked.

For several years, the One Minute Manager was the rage and we were told to sandwich critical comments between two positive ideas. Most of us tend to hear what we want to hear, so our employee often heard only the positive, last comment and nothing changed.

Another communication skill, contrasting, seems to work better. Contrasting is simply “saying what you don’t mean, followed by what you do mean,” and is described by Patterson, et al in Crucial Conversations (great book – full of helpful communication skills).

Let’s say we have an employee who does a good job – but consistently arrives 15 minutes late. We would start by telling him that there was something we wanted to talk with him about and asking if this was a good time to talk. Then we would anticipate what he might incorrectly assume if we simply corrected his behavior – that we were unhappy with him as an employee – and assure him that we didn’t mean that: I don’t mean to imply that I’m unhappy with the quality of your work here. After that, we would tell him what we do mean: I enjoy working with you and feel that you are a real asset to the practice. Finally, we would end with the change in behavior that we expect: I’ve often seen you arrive late and I need you to be in the office, ready to work, by 8:00 every morning.

This sequence first puts the employee at ease by declaring your overall approval of his work and appreciation of his contribution to the office. Then, it clearly defines the change in behavior that you are seeking. This is the last thing that he hears, increasing the chance that the message will land. Sounds simple, doesn’t it? Even better, it actually works.


About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
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