I believe the approaches outlined are spot-on for well-defined and structurally aligned teams. Unfortunately, for the most part, our physician colleagues haven’t yet acknowledged a place on the healthcare team. With the exception of hospital-employed physicians that may be more likely to acknowledge such a place, the majority of physicians still see themselves as independent contractors without formal connection. Thus, they’re more likely to bristle when
challenged and likely will escalate whatever tensions might be developing. I’ve personally
heard phrases such as “Who do you think YOU are to judge my comments as rude?
What IS rude is a system of people that don’t allow me to work efficiently!”

In my experience, maintenance of the “higher ground” is a better approach. “Deflecting” tension with an inquiry or statement that presumes the rudeness was either inadvertent or not intended, followed by a sincere pursuit of partnering with the individual is more likely
to achieve success than “confrontation” in the model of crucial conversations
within and among teams. We have to begin to accept that disruptive behavior is a symptom of an individual’s suffering.

If and when we achieve the physicians’ acknowledgement of team, Mr. Switzler’s
model should work as well as it does in other settings. Until that time,
however, I would favor the alternative approach referenced above.

Daniel L. Kopp, MD
Recent CMO at Faxton St. Luke’s Healthcare in Utica, New York

We have found working with groups to clarify these issues around “rudeness” “courtesy” and “civility” clears the air and helps get the group re-committed to working with each other in a way that works. for them.

A few concepts: we want to find Mutual Purpose and show Mutual Respect; we suggest looking for What’s Right, instead of What’s Wrong in a comment; and we recommend looking at the Purpose behind the Strategy. What if we used a combination of these approaches to find the common ground between the meeting member’s idea and the boss’s criticism?

Suppose the meeting member, Jane, suggested something like, “Why don’t we get Justin Bieber to endorse our campaign?” And the boss said, “Justin Bieber??? Are you crazy? That guy would charge us $100K for each appearance!”

You might look for What’s Right–the Purpose behind the Strategy. Find a way to endorse and respect Jane’s idea and the boss’s comment–take them to their common ground: “I like where Jane is going–even if we can’t afford Justin Bieber. We could find a way to get opinion leaders in that demographic to support our cause.”

How would that work for people? I’m looking for a low-risk way to bring the group back together and back on course.

David

Atleast the team shall have one strong emotionally balanced guy who can intervene and make amends …..

Think of an orchestra conductor who realizes the string section is a bit off time. Her choice is to ignore it, and give up on a great concert, or call a time-out, to practice in front of the audience. Of course, that’s not what conductors do. Instead, they signal the section (or an individual or entire orchestra) using just the tip of their baton. No one in the audience can even see it.

The goal is to cue the offender back onto course. The way you do it is with just half of what Al suggested. Instead of describing what was expected versus what was observed, you only describe what you are expecting. You signal what you want, but you don’t single out the offender.

For example, let’s say that the big boss has just described someone’s idea as “idiotic.” You might say, “Right now I think we want to generate as many ideas as we can. Can we hold off evaluating them until we have a whole bunch on the table?”

The goal is to get the boss back on track without calling attention to his/her bad behavior. Of course, signalling doesn’t always work. Then you are faced with a bigger challenge. But try tipping the baton first. I find it works more often than not.

I’m cautious about siccom’s idea of supporting the person who has been attacked. If I’m the boss, I might think I haven’t made my point clear–and try making it even clearer (and louder).

This might turn the conversation back to the subject without being a direct rebuke to the inferior superior.

I await feedback on this idea…