Giving Feedback, Pt. 2: Challenging Situations and Conversations Bedi/Fraser Team

Objectives Faculty will be able to: Identify common teaching challenges. Define their own personal challenges in difficult teaching situations. Learn brief techniques for confronting, correcting, and teaching in difficult situations. Develop a personal goal to role model how to handle a challenging interpersonal situation.

Characteristics of Difficult Residents

Characteristics of Difficult Residents Poor insight Challenge your experience Resist feedback Unorganized Arrogant Overconfident Insensitive to patient needs “Unconsciously incompetent” Lack initiative Avoidant Lone ranger Condescending Rude to staff Non-participatory Slow worker Lack of attention to detail Miss the big picture Poor knowledge base

Behaviors of Difficult Residents

Behaviors of Difficult Residents Disrupt work flow Distracting Defensive to feedback Disrupt the team Avoid the team Evasive Sway opinions Whining Complaining Poor role models Create poor reputation Lateness No show for clinic Arguing/conflict

How do we react to them??? Avoid Get angry Talk behind their back Get rattled Get off track Disrupt our work flow Get upset/cry

“Outside” Issues That Can Affect Resident Performance Relationship/Family stress Psychiatric illness Substance abuse Financial issues

“Crucial Conversations” Strong Emotions Opposing Opinions Crucial Conversations High Stakes Patterson, K., Grenny, J., McMillan, R., Switzler, A., Crucial Conversations: Tools for Talking When Stakes are High. New York, NY: McGraw Hill; 2012.

During Stress, it Is Difficult to Act Do you Sugarcoat? Demand your way? Run or avoid? Resolve through dialogue and relationship? (Please note: the remainder of the slides are taken from the two references listed on the last slide.)

CC—the Wrong Way… Withdrawing —Pulling out of communication completely; physical, emotional, psychological Avoiding —staying away from unsafe topics or issues Masking —understating, sugar coating, sarcasm, selectively showing Controlling —coercing others: interrupting, overstating, absolutes Labeling —trying to win or have others give in through ridiculing their ideas Attacking —making sure others hurt; emotional, physical, psychological

CC—the Right Way: 7 Principles Start with Heart -focus on what you really want Learn to Look -is “safety” deteriorating? Make it Safe -identify mutual purpose Master My Stories -clarified, unbiased STATE My Path – share facts tell story ask for others talk tentatively encourage testing Explore Others’ Paths -ask, paraphrase, agree, build, compare Move to Action -finish clearly

“Modifying Motivation: Encouraging Difficult Learners” “[As residency educators, we have the] challenging opportunity to make sure all learners have both the ability and willingness to do their jobs. Both ability and willingness depend on learners having a high level of independence, self-reliance, self-trust, and the capacity to exercise initiative—in a word, self-esteem.”

Motivation allows movement along a continuum NEGATIVE POSITIVE ENCOURAGEMENT Superstars Difficult learners

Skills of Encouragement 1. Show complete acceptance Conditional environments only create discouragement.

Skills of Encouragement 2. Express empathy When you can walk in the learner’s shoes, their behaviors, thoughts and feelings make sense.

Skills of Encouragement 3. Show confidence This encourages the learner to be more actively involved.

Skills of Encouragement 4. Focus on strengths and assets Find out all you can about the learner and play to their strengths. Turn liabilities into assets.

Skills of Encouragement 5. Focus on Effort and Improvement Recognize effort (not outcome) and improvement (not comparison to prior performance.)

Skills of Encouragement 7. Set learning goals Performance standards Short-term Within learner’s ability level

Skills of Encouragement 8. Coach by Encouragement “See if this works better for you.” “Why don’t you try a different approach?” “Let me offer a suggestion?”

Skills of Encouragement 9. Give Encouraging Feedback “Look how much better it went this time.” “You’re making progress. Hang in there.” “I hope you feel good about your improvement.”

Skills of Encouragement 10. Give encouraging performance evaluations 11. Encourage Self-Evaluation 12. Encourage Self-Encouragement

Role Plays Encouragement Crucial Conversations Start with Heart 1. Show complete acceptance 2. Express empathy 3. Show confidence 4. Focus on strengths and assets 5. Focus on Effort and Improvement 6. Facilitate Decision “Doing” 7. Set learning goals 8. Coach by Encouragement 9. Give Encouraging Feedback 10. Give encouraging performance evaluations 11. Encourage Self-Evaluation 12. Encourage Self-Encouragement Start with Heart Learn to Look Make it Safe Master My Stories STATE My Path share facts tell story ask for others talk tentatively encourage testing Explore Others’ Paths Move to Action

Final Reflections… What is one thing you can walk away with and do differently after this workshop?

Crucial Conversations: SOME EXAMPLES Giving a resident negative feedback Addressing a grave patient care error Dealing with a resident who is being disrespectful Addressing a resident who has been rude to a fellow staff member Confronting a resident about inappropriate comments in a meeting Giving negative feedback to a boss or superior Confronting a co-worker who is emotionally fragile Giving feedback to a resident who just isn’t getting it

References Patterson, K., Grenny, J., McMillan, R., Switzler, A., Crucial Conversations: Tools for Talking When Stakes are High. New York, NY: McGraw Hill; 2012. Patterson, K., Grenny, J., McMillan, R., Switzler, A., Crucial Confrontations: Tools for Resolving Broken Promises, Violated Expectations, and Bad Beharior. New York, NY: McGraw Hill; 2005.