Crucial ability: Disclosure
Crucial ability P Peter t TW Watson, t MD Northwest Perinatal Center Women’s Healthcare Associates Portland, OR
Crucial ability • Patterson K et al, Crucial ability: Tools for Resolving Violated Expectations, B k C Broken Commitments it t and dB Bad dB Behavior, h i 2nd Edition, 2013; New York, McGraw-Hill.
Crucial ability Conversations: The most important personal characteristic for making change happen is: “A A willingness to enter into crucial ability conversations and an ability to make them successful; i.e., to solve problems and to build relationships.”
• “I have numerous interesting conflicts and will talk about almost all of them at any opportunity. pp y I don’t approve pp of drugs, g , products, or devices and can guarantee they won’t come up in conversation today or any day” Peter T Watson, MD
Crucial ability: Definition • A subset of crucial conversations (i.e., when opinions vary, emotions run strong, and stakes are high.) • Crucial conversations = disagreements • Crucial ability = disappointments (i.e., violated expectations, broken commitments, bad behavior.)
Crucial Conversations High Stakes
Strong Emotions
Crucial Conversation Differing Opinions
Patterson, K et al. Crucial ability, 2013.
Crucial ability • Violated Expectations • Broken Commitments • Bad Behavior
Crucial ability Conversations: Choices
Crucial ability: Examples • Daughter on first date agrees to curfew, comes home two hours late. • Beloved boss agrees to protocols then breaks them repeatedly repeatedly. • Co-pilot sees ice on wings, notifies pilot who checked them. Pilot ignores him. • Shuttle engineer discovers O-ring failure, fails to notify responsible superiors.
Crucial ability: Fool’s Choice
• Avoid them
• Speak up and make an enemy or …
• Face them and perform poorly
• Stay silent and continue to suffer while a problem goes unsolved.
• Face them and perform well
Crucial ability: Fundamental Consequence
Crucial ability: Fundamental Observations • You are not only responsible for what you say, but also for what you don’t say.”
• “ If you don’t don t talk it out, out you will act it out out.”
Patterson, K et al. Crucial ability, 2013.
– Martin Luther
• “I always wondered why somebody didn’t do something about that, then I realized I was somebody.” – Lily Tomlin
Crucial ability: If and What • Before you embark on an ability discussion: • Decide if you should have the conversation in the first place. • And if so, what kind of conversation should you have?
Crucial ability: Questions (if you’ve decided to have the conversation.) • How can I be effective when I’m so nervous? • Can I be 100% honest and yet 100% respectful? • Is this skill innate or can it be learned? • What are the steps involved?
Crucial ability: R
Crucial ability Conversations: When not to have them (without help.) • Personal danger: Leave, call for help, notify HR • Illegality: Call HR, legal counsel, senior partner, practice manager • Adverse peer pressure: Discuss with HR, influential peers, mentors. • Significant uncertainty: Discuss with HR, mentors.
Crucial ability: Getting Started • You need to hold a Crucial ability Conversation but you’re stuck. What’s the issue and what sort of issue is it? • Unbundle it with R – Content – Pattern – Relationship
Crucial ability: Start with Heart (Most Important Question)
• Unbundle it with R – Content: A specific event or issue – Pattern: A set of ongoing events or issues – Relationship: A set of interactions between two or more individuals affecting results
• What do you really want: –For For you? –For others? –For the relationship?
Crucial ability: Start with Heart (Questions)
Crucial ability: Conversation Goals
• What are you acting like you really want? • What do you really want? • How would you behave if you really wanted t d thi this? ? • What do you not want? • How should you go about getting what you want and avoiding what you don’t want?
• Make it clear: Describe the gap between what was expected and what happened. • Make it dialogue: “the free flow of meaning between two or more people people.” • Make it safe for all parties. • Make it effective: Diagnose sources of influence. • Make it last: Establish follow-up.
Crucial ability: Overview
• Before:
Crucial ability: Key Steps
Work On Me First Get Unstuck Start with Heart Master My Story
• During:
Silence Safety
State My Path
POOL OF SHARED MEANING
Learn to Look Make it Safe Explore Other’s Path
Safety
• After:
Violence
• • • • • • • •
Start with heart: Focus on goals. Master your story: Regardless of anger or fear. State your path: Persuasion without abrasion. Learn to look: Notice when safety is at risk. Make it safe: Regardless of content. Clarify intent. Explore others paths: Despite silence or violence. Diagnose: Discuss the six sources of influence. Move to action: Turn dialogue into results.
Diagnose Sources of Influence Move To Action Who Does What By When; Follow-up
Crucial ability: Master your Stories (Path to Action)
SEE AND HEAR
TELL A STORY
FEEL
ACT
Crucial ability: Master your Stories (Path to Action) • • • •
See and Hear: A factual event or events. Tell a Story: y How y you interpret p the event(s). ( ) Feel: How you feel about your interpretation. Act: How you act on your feelings.
Crucial ability: Master your Stories (Skills) • Retrace your path to action. • Separate fact from story. • Watch for three clever stories: villain, victim, or helpless stories. • Tell the rest of the story.
Crucial ability: Master your Stories (Sellouts) • Clever stories lead to sellouts • Sellouts: conscious actions against your own best interest: – You Y b believe li you should h ld apologize, l i b butt d don’t. ’t – You see a problem and don’t speak up.
• Tell yourself useful stories instead, they’re closer to accurate, complete, the rest of the story.
Crucial ability: You have a Tough Message; To Be Honest and Maintain Safety: State your Path • • • • • •
Share your facts re the gap Tell your story Ask for others’ paths Talk tentatively Encourage testing (Always end with a question)
Crucial ability: Master your Stories (Three Clever Stories) • Victim stories: It’s not my fault. My motives are pure. • Villain stories: It’s his or her fault. Their motives are indefensible indefensible. • Helpless stories: There’s nothing I can do. It’s his or her fault. I have only the Fool’s Choice, stay silent and suffer, or speak out and ruin the relationship, be punished, etc.
Crucial ability: Useful Stories • What is my story? Is it a useful story? • What am I pretending not to know about my role in the problem? • Why would a reasonable, rational, decent other person do this? (Imagine the best of others, start with benefit of the doubt.) • What should I do right now to move toward what I really want?
Crucial ability: You have a Tough Message; To Be Honest and Maintain Safety: State your Path • Share your facts re the gap – “I noticed…” “Twice you…” • Tell your story – “It seems to me…”; “I wonder if…” • Ask for others’ paths – “How do you see it?”; “Help me understand…” • Talk tentatively – Avoid absolutes. Own your story. • Encourage testing (Always end with a question) – “Do you see it differently?” “What am I missing?”
Crucial ability: Overview
Crucial ability: State your Path ( Key Questions)
• Before:
Work On Me First Get Unstuck Start with Heart Master My Story
• Am I really open to other’s views?
• During:
Silence Safety
• Am I talking about the most important issue?
State My Path
POOL OF SHARED MEANING
Learn to Look Make it Safe Explore Other’s Path
Safety
• Am I confidently expressing my own views?
• After:
Violence Diagnose Sources of Influence Move To Action Who Does What By When; Follow-up
Crucial ability: Learn to Look for Safety (or Lack of It) • Look for when the conversation becomes critical (i.e., hostile, tense, one-sided.) • Look for safety problems. • Look for signs of stress.
Crucial ability: Learn to Look for Lack of Safety
• Am I withdrawing or attacking (silence or violence?) • Are others either withdrawing or attacking?
Crucial ability: Make it Safe
Crucial ability: Make it Safe
• People get defensive when they feel unsafe. • People rarely get defensive about what it is you’re you re saying (Content.) (Content ) • If people are defensive, it’s usually about why they think you’re saying it (Intent.)
• Clarify intent by building mutual purpose and mutual respect. • Mutual Purpose: “You You believe I care about your goals and vice versa.” • Mutual Respect: “You believe I care about you as a person and vice versa.”
Crucial ability: Make it Safe Clear Problem
Crucial ability: Make it Safe
Misunderstanding
Mutual Respect
Apologize
Contrast
• Apologize when appropriate.
Mutual Purpose
Create Mutual Purpose
Contrast
• Contrast to fix misunderstandings.
Crucial ability: Make it Safe (Contrasting to Fix Misunderstandings) • Start with what you don’t intend or mean. – “I don’t think/mean/want to…” (Try to avoid “but” in between.)
• Then explain what you do intend or mean – What I do think/mean/want to is …”
Crucial ability: When Others are Silent or Violent, Explore their Paths with AMPP • Ask: To get things started. – “I’d like to hear you opinion on this.” • Mirror: To confirm feelings. – “You You say you’re you re OK OK, but you seem upset upset.” • Paraphrase: To acknowledge their story. – “Let’s see if I’ve got this right…” • Prime: If you’re getting nowhere. – “ Let me guess, you thinking (feeling)…” – (Now you’re ready for a discussion about motivation and ability)
Crucial ability: Overview
• Before:
Crucial ability
Work On Me First Get Unstuck Start with Heart Master My Story
• During:
• “People change their behavior when
Silence Safety
State My Path
POOL OF SHARED MEANING
Learn to Look Make it Safe Explore Other’s Path
they re both motivated and able to do they’re so.”
Safety
• After:
Violence Diagnose Sources of Influence Move To Action Who Does What By When; Follow-up
Joseph Grenny, in Crucial ability, 2013.
Crucial ability: Six Sources of Influence
Crucial ability: Personal Motivation • Left by yourself, would you want to…?
Motivation
Make it Motivating
Ability
Personal
1
2
Social
3
4
5
6
Structural
– Do you hate or enjoy it ? – Do you find meaning in it ? – Does it fit with who you want to be ? Make it Easy
• Sounds like… – “I don’t like…” – “That’s not fun for me…” – “That’s just who I am…”
Patterson, K et al. Crucial ability, 2013.
Crucial ability: Personal Ability • Left by yourself, do you have the knowledge, skills, and physical ability to …? • Sounds like… – “I can’t ’t physically…” h i ll ” – I don’t know how…” – I keep trying, but I can’t figure it out …”
Crucial ability: Social Ability • Do others (including me) provide or withhold the help, information, or resources required at critical times ? • Sounds like… – “He didn’t get me the material I needed…” – “She didn’t teach me the new system…” – “I needed her approval, but she said no…”
Crucial ability: Social Motivation • Are other people (including me) encouraging the right behavior or discouraging the wrong behavior ? • Sounds like... – “The boss told me to do this…” – She’s been praising this for months…” – Everyone is doing this…”
Crucial ability: Structural Motivation • Are the non-human motivators (pay, performance reviews, promotions, perks, costs, etc.) encouraging the right behaviors or discouraging the wrong behaviors? • Sounds like… – “That won’t affect my yearly review…” – “That’s not what I get paid to do…”
Crucial ability: Structural Ability • Does the environment (equipment, facilities, information, policies, proximity to others, etc.) enable good behavior or bad? • Sounds like like… – “This ultrasound machine can’t give me the images I need…” – “This policy gets in the way of good care…” – “I struggle counseling patients with all this noise…”
Crucial ability: Six Sources of Influence • Removing Ability Barriers, Making it Easy – Start here; ability often fixes motivation – Clarify boundaries, constraints – Ask for ideas; empowers, motivates, likely to produce the best suggestions – Don’t… • Play “read my mind” • Leap in with a suggestion • Discourage others’ suggestions • Worry about having to know everything • Feel the need to solve everything
Crucial ability: Six Sources of Influence Motivation Personal Make it Motivating
Social Structural
1
2 4
5
6
• Limitations of Diagnosis – Causes can be complicated – Motivation M ti ti and d ability bilit can b be lilinked k d – Responses may be ambiguous – Responses may be masked – Diagnosing can sound like excusing
Crucial ability: Six Sources of Influence • Make it Motivating – Look for self-motivation – Avoid trying to motivate with power (i.e., leading with imposed consequences) – Clarify natural consequences instead (i.e.; make the invisible visible) – Consider all three motivational sources (personal, social, structural) – Return to ability barriers as a final step
Crucial ability: Moving to Action • “The way you complete an ability conversation is as important as how you start it; if you swap your backbone for a wishbone, you set yourself up for a whole new set of problems.”
Ability
3
Crucial ability: Six Sources of Influence
– Joseph p Grenny y
Make it Easy
• “Those people blessed with the most talent don’t necessarily outperform everyone else. It’s the people with follow-through who excel.” – Mary Kay Ash
• “Action is the foundational key to all success.” – Pablo Picasso
Patterson, K et al. Crucial ability, 2013.
Crucial ability: Move to Action (Questions) • Who will do what by when? • How will we follow up? p – Check-up or check-back?
• Do others need to be involved? – Lead – Manager (e.g., Practice Manager, Managing Partner) – HR
Crucial ability Conversations: Start with the heart • Focus on what you really want. –For you, others, relationship
• Refuse the Fool’s Choice –Speak up and make an enemy or stay silent to preserve the relationship.
Crucial ability Conversations: The most important personal characteristic for making change happen is: “A willingness illi t enter to t into i t crucial i l ability conversations and an ability to make them successful; i.e., to solve problems and to build relationships”