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M7: Personal Mastery for Relational Barriers to Change

Neil Baker M.D.Neil Baker Consulting and Coaching

Bainbridge Island, Washingtonneil@njbaker.net

Institute for Healthcare Improvement 28th Annual National Forum

December 5, 2016

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No disclosures

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Objectives

• Explain methods for identifying and shifting out of reactions to complexity and stress that get in the way of high quality work relationships.

• Define your personal vision for high quality work relationships and translate that into behavioral specifics.

• Explain the key elements of dialogue for working through difficult situations.

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A practice

• Reflect: Recognize and manage personal reactivity. – Recognize reactivity. – Orient to your vision for results + relationships.. – Get in their shoes. – Prepare (thoughts, feelings, curiosity).

• Dialogue: Sustain two-way conversations.

• Decide: Use a mutually clear decision making process to choose action.

• Follow-up/Align: Follow-up, learn, check alignment, and adjust course .

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Agenda

• Introductions, norms, and challenges 8:30 – 9:30

• Reactivity, Reflection 9:30 – 10:00, 10:30 – 11:00

• Dialogue 11:00 – 12:00

• Case discussions for application 1:00 – 2:30, 3:00 – 3:30

• What will you do by next Tuesday? 3:30 – 4:00

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Introductions and Norms/Behavioral Specifics for True North • 1 minuteWhat behaviors/ways of interacting will help us create and sustain a safe, generative learning environment.?

• Give your name, where you are from, and one norm/behavioral specific

• Givens– Confidentiality—no names or identifying details– Move quickly out of judgment, blame, personality diagnoses,

and attributions of intent.

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Identify relational challenges

• I min. to reflect alone

– What important relational challenge do you bring to this meeting?

– What do you hope to get from and give to others today?

• 4 min. X 2 with people you don’t know

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A practice

• Reflect: Recognize and manage personal reactivity.

– Recognize reactivity.

– Orient to your vision for results + relationships..

– Get in their shoes.

– Prepare (thoughts, feelings, curiosity).

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reactivity creativity

Judgment, blame, Personal accountability,personality diagnoses what’s working and not working

Pushing ideas or withdrawal into silence Joint exploration of all ideas

Unbalanced participation Balanced participation

Stuck in conflict or no conflict Conflict surfaced and managed

Decisions premature or Balanced dialogue and decision delayed making

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Ladder of Inference

Interpretations, assumptions, judgments, conclusions, opinions, meanings,attributions of intent

Selection of data

Observable data and experience(e.g. actual words and/or behaviors you could haveobserved or heard)

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Interpretation or data in words/behavior?

1. John was aggressive.

2. He was trying to make us angry.

3. My perception is that’s the third time you started to talk while I was talking.

4. The leaders are just not trustworthy.

5. Jim said nothing when Jack said “You are wrong.”

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Watch for “I feel that….…you have poor judgment.”

(judgments)

…it’s your fault!”(blame)

…you are attacking me!”(attributions)

…you are passive-aggressive.”(generalizations)

…the answer is…”(cognitive)

Bundles of feelings andthoughts

Created by Neil Baker M.D. for AACH

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Name feelings in single words.Modulate intensity.

High intensity

Pissed off

Angry

Shocked

Low intensity

Concerned

Unsettled

Puzzled

Created by Neil Baker M.D. for AACH

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ReflectRecognize Orient to vision for

results andrelationships

Prepare

Get in their shoes

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Exercise6 min. alone, 4 min. pairs

• Think of a tough interaction you have currently or had in the past.

– Identify a few thoughts.

• Which were up the ladder?

• Which were down the ladder?

– Identify one or more feelings in one or two words.

• What are low vs. high intensity expressions?

– What did you learn about how certain thoughts and feelings may have contributed to the problems?

• Identify signs of reactivity and triggering situations.

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Recognition

• Power differentials I don’t assert myself enough. I remain too silent.

• Resistance I feel judgmental and then I either remain silent out of

fear of others feeling judged or I am too blunt and

provoke anger.

• When I have strong opinions I have trouble asking and listening in the same conversation

so people feel pushed or dominated.

• People holding onto I stay silent out of concerns about losing a feeling of

unproductive thinking mutuality or getting into debates and struggle

Triggering situations Reactions

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Dialogue: sustain two-way conversations

Active

telling

Check understanding

Active listening

Check understanding

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• State intentions.

– Explicitly set aside decision making to explore

all viewpoints and assure mutual understanding.

– Explain what you hope for with the issue/tasks at hand and for the quality of work relationships you would like to build.

• Build understanding of each participants' aims and challenges.

• Clarify mutual aims/interests (vs. debating positions).

• Generate multiple options for action.

• Use cycles of active listening, active telling, and checking understanding.

Dialogue: principles

adapted from multiple sources especially

Fisher et al Getting to Yes: Negotiating Agreement Without Giving In 2014

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• What are your ideas/perceptions?– Here is what I heard you say. – Did I get that right?– What observations are you basing that on?

• Can I tell you my ideas/perceptions?– What did you hear me say?– Do you understand what I am basing this on?– What am I missing? Where might I be wrong?

Dialogue: check understanding

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Goleman et al Primal Leadership 2013

“The slightest voice inflection, the most innocent remark, can land hard on those you have authority over, causing them to make up stories that support increased caution and distort further interaction."

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On Being Unconditionally Constructive

It is better to assume that reciprocal good will and behavior usually require ongoing

hard work if they do occur at all.

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Norms for feedback4 min alone, 10 min. in pairs

• Think of a time when you received feedback that made you feel bad, angry, or disrespected. What were the behaviors that led to these feelings—The MUST NOT DOs.

• Thinks of a time when you received feedback which was done in a way that was relatively easy to hear and you felt respected. What were the behaviors that led to feeling respected—THE MUST DOs

• Circle 4 – 5 (total including both columns) that seem most important to you right now. Make them into norm statements.

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True North, Broad Vision Statemenmt

• My intention is to build a team that is closely knit and devoted to continuously improving our outcomes and work process. This depends on mutual respect and a commitment to helping each other solve problems. We respect and stand by each other at all times.

• We assume good intentions and highly value each individual person. When problems arise between us, we will always work them out directly with each other avoiding assumptions and and valuing people at all times as opposed to identifying people with their behaviors.

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True North, Norms/Behavioral Specifics

• We listen to each other and ask questions to understand what is going on and why.

• We do not jump to conclusions about other people without checking them out.

• We solve problems directly with the person involved and ask for help from our supervisor together if we run into roadblocks.

• When someone asks for help, we will pitch in if we can and, if we cannot, will stay involved to find other solutions.

– The words “I can’t.” and “It’s not my job.” are not part of our work together.

• We assume good intentions and that all of us can offer high value to the team. We quickly identify complaining and move out of it to problem solve together.

• As a Director, my intention is to help the team become the best it can be and to empower people to solve their problems. I will listen to requests for help and resources at all times and will join in in finding solutions together.

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A practice

• Reflect: Recognize and manage personal reactivity. – Recognize reactivity. – Orient to your vision for results + relationships.. – Get in their shoes. – Prepare (thoughts, feelings, curiosity).

• Dialogue: Sustain two-way conversations.

• Decide: Use a mutually clear decision making process to choose action.

• Follow-up/Align: Follow-up, learn, check alignment, and adjust course .

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Facilitate

Engagement

Dialogue and Discovery

Stay the

Course

Decision making

Power

DECISION MAKING KEYS to maximize chances for engagement

• Clarity about who has the authority, decision type, and process

• emphasize input via dialogue

• Explain decisions via dialogue

• in service of vision, not control

• acknowledge downsides and risks

• elicit reactions and concerns

• Engage in implementation design and problem solving to address concerns

POWER EMPOWERMENT

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Group Consultation

As there is no one right answer in human affairs, we rapidly share challenges in order to:

– Expand awareness and interpretations.

– Generate multiple options.

– Identify relevant principles and methods.

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Working with complex challenges• Move quickly out of judgment, blame, personality diagnoses.

• Suspend certainty. There is no one right answer.

– Search for and explore differences.

– Avoid debates about “right or wrong.” Generate “pros and cons” or “reasons for higher and lower risk.”

– Look at the underlying data and principles for ideas.

• Offer hunches, wild guesses, bad ideas, completely wrong ideas.

• If the case does not feel relevant to you, it helps to mention it.

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Questions

• What are your interpretations of what is going on?

• What are at least four possible strategies?

As part of the discussion:

– How do the strategies connect to the practices?

– What are the pros and cons of the strategies?

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Closing

• Action ideas:

– Based on the case, what actions will you take by next Tuesday?

• Review of meeting:

– What worked well? What could be improved?

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Questions about resources?email: neil@njbaker.net

Additional articles and tools atwww.neilbakerconsulting.com

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