Communicating with humansTimothy Gilligan, MD

Associate Professor of MedicineVice-Chair for EducationTaussig Cancer Institute

Director of CoachingCenter for Excellence in Healthcare Communication

Cleveland Clinic

Why am I here?

Our story

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2008 2009 2010 2011 2012 2013 2014 2015

Mayo Mass GenJohns Hopkins UCLACC 50th

HCAHPS Doctor Communication 2015Sites > 1000 Beds

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National 90th

Agenda for our time together

• Why focus on communication and communication skills?

• What are relationship—centered communication skills?

• How can a coach approach help us when working with others?

If we want different outcomes, are we willing to change our behavior to try to get them?

The goal

• To behave in a manner that results in the outcomes that we want

• To be the kind of person that we aspire to be

• To have functional and fulfilling relationships

The current reality

• We routinely engage in behaviors that predictably result in outcomes that we do not want

• Why?• We haven’t been trained well.

• We don’t take communication skills seriously.

• We attend to our emotional needs & what feels good/safe instead of attending to the outcomes that will work better for us.

What do people need?

• Safety

• Control

• To feel valued

• To feel respected

• Connection to other people

Exercise

• Turn to the person sitting next to you

• Introduce yourself if you don’t know them

• Take 90 seconds to tell them about something at work that you are excited about, proud of or looking forward to.

Exercise

• Turn to your neighbor and tell him/her about a recent communication challenge that you faced.

• Questions to consider:• What sort of situations or scenarios do you find

most challenging, difficult or unpleasant?

• What skills do you have that help you?

• What would you like to be better at?

So what does this have to do with SCORE?

Three stories

My roommate

My patient

One of my relatives

Three stories

My roommate

My patient

One of my relatives

Agenda for the rest of this hour

• Relationship-centered communication skills

• Coaching skills and practices

Relationship-Centered Communication

R elationship:

E stablishment

D evelopment

E ngagement

The R.E.D.E. ModelSM of Healthcare Communication

E

M

P

A

T

H

Y

Key skills for relationship-centered communication

• Listening

• Curiosity

• Expressing empathy

• Power sharing• Who does most of the talking?

• Who sets the agenda?

• Who develops the plan?

• Conflict engagement & resolution

What communication skills do we need to be able to implement?

• How to connect with other human beings

• How to listen without controlling the conversation

• How to recognize, identify and respond to emotion

• How to respond constructively to difference, disagreement and conflict

• How to communicate in such a way that the listener understands and remembers

“To listen is very hard, because it asks of us so much interior stability that we no longer need to prove ourselves by speeches, arguments, statements or declarations. True listeners no longer have an inner need to make their presence known. They are free to receive, welcome, to accept.”

Henri Nouwen

Listening

From Lipmanowicz, Henri; McCandless, Keith. The Surprising Power of

Liberating Structures: Simple Rules to Unleash A Culture of Innovation.

Reflective Listening

• DO:• Reflect back what you are hearing to confirm accurate

understanding• What I hear you saying is …

• It sounds like …

• Express empathy

• Pay attention

• DO NOT:• Respond with your own story or anecdote

• Ask questions that steer the conversation

Questions to elicit the story

• How is this problem affecting you or your organization? What is the impact?

• What ideas do you have about this problem?

• What are you hoping for?

• What are you most worried about?

Us as broadcasters

A simple question to ask ourselves:

How much of the time am I transmitting?

How much of the time am I receiving?

What changes if I spend more time receiving?

Curiosity

What happens when we replace judgment with curiosity?

Curiosity

Every time I open my mouth, I risk making things worse.

Empathy

What is it?

Empathy

• What is Required for Empathy

1. Presence

2. Notice emotion

3. Imagine how the other person is feeling

4. Express understanding of the other person’s

feelings and experience

Kelm Z et al, BMC Med Ed; 2014;14:219

SAVE

• Supportive or partnering statements• I want to help you with this.

• Acknowledgment• This has been a very stressful time for you

• Validation• Anyone in this situation would feel the way you do

• Emotion naming• You seem really frustrated today.

Which realm are you in?

Emotional Cognitive

“Don’t freak out – it’s just a save-the-date.”

R elationship:

E stablishment

D evelopment

E ngagement

The R.E.D.E. ModelSM of Healthcare Communication

E

M

P

A

T

H

Y

Applying these skills to conflict

• Leading with curiosity to understand the other person’s perspective.

• Articulating your understanding of their perspective.

• Separating the person from the problem.

• Distinguishing interests from positions.

• Looking for common ground.

Coaching

What is coaching?

• Bringing order and structure and discipline to the often chaotic process of self-assessment and self-improvement.

• Asking people to take responsibility for the predictable consequences of their behavior.

• Facilitating a process for people to develop their own solutions, strategies, and pathways for getting to where they want to be.

• Enhancing reflective capacity and the ability to see opportunity.

Reflective practice cycle married to Quality improvement cycle (PDSA)

What is our

current

reality?

What is our

ideal

state?

How can

we move

toward the

ideal?

What

results

did we

achieve?

Dream

PlanAct

(Re)Assess

Coaching processes

• Powerful questions

• Asset-based thinking

• Reflective listening

• Accountability

Powerful questions

• Where do I want to be?

• What does success look like to me?

• What would I gain and lose by achieving this goal?

• Where am I getting stuck?

• What has helped me succeed in the past?

Asset-based thinking

• Focus is on the future

• Focus on areas where coachee has influence, power

• Solutions, strengths, opportunities, and actions rather than …problems, barriers, mistakes and causes

• Reflect on past experiences of success and how they can be recreated

Practicing specific questions

• What would you like to see in the future?

• When do you feel most engaged by your work?

• When have you been successful in this before?

• What made you successful before?

• How can you do more of that now/going forward?

Asset-Based Questions

Illuminating blind spots

• I noticed that you have not mentioned ______. Is there any particular reason?

• What other possible explanations have you considered?

• Would it be ok with you if I tell you what I think?

Structuring the coaching process

1) Building a relationship

2) Needs assessment & goal setting

3) Designing a plan

4) Managing progress and accountability

Take Homes

• Committing to communicating more effectively is a way to more consistent achieve the outcomes that you want.

• Communicating effectively requires skills, and mastering skills requires practice.

• People can improve with practice and skilled feedback.

“

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When you try to control, you lose the opportunity to influence.

Judy Campbell, JC Strategies