EP 44: Fostering a Healthy Work Culture with Radical Candor and Effective Feedback

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Renee Thompson:
Plants thrive and grow in a peaceful, nourished environment, right? Well, it's the same with human beings. But what if that environment is not so peaceful? What if it's toxic? Welcome to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. In this podcast, you'll get practical, evidence-based strategies to help you cultivate and sustain a healthy and respectful work culture by tackling an age-old problem in healthcare: bullying and incivility. I am your host, Dr. Renee Thompson.

Renee Thompson:
Hi, everyone! Welcome back to another episode of the Coffee Break Podcast. Hope you're having a great week and that you're in a good place. Okay, as you know, bullying and incivility exist because they can, and it takes dedicated leaders like you to do something about it. And that's really what this podcast is all about is giving you the practical strategies, knowledge, skills, and tools that you need to actually address disruptive behaviors, bullying and incivility, workplace violence so that you can ultimately cultivate a healthier work culture. And it's just me today, okay? And I want to chat about two things. The first is coffee. Okay. We're just going to talk about coffee. I love coffee. And then we're going to talk about one of the most important skills, in my opinion, that leaders need to develop. Okay. But first, coffee. I get asked this question all the time. What's the deal with coffee? All right, so I had a YouTube video series called Coffee and Conversations about Nurse bullying. I tell a story. It's actually becoming famous where people say, Well, tell your coffee slurping story, okay? So, I talk about coffee when I'm presenting. With a lot of my clients, will do a series of webinars, and then we follow up with what I call a coffee chat. My podcast, when I was developing this and coming up with the title, of course, I had to have the word coffee in it. And actually, in the very first episode I explained this, but I want to share it again. Why coffee? When I was a little girl, I knew it was going to be a good evening when I saw my mom put the percolator, the old-fashioned coffee pot, on the stove after dinner. That meant that either one of her neighbors was coming over, or maybe one of her sisters, or it could be my grandmother were coming over after dinner, and they were going to sit in the kitchen, and they were going to have a chit-chat. And I remember thinking, when I get older, I want to drink coffee and have my friends over, maybe my sisters, and just have a chit-chat. Every single time I record an episode, whether I'm doing this solo or I have a guest, I just pretend that I'm either in a coffee shop or in my kitchen, just sitting there having a cup of coffee and a chit-chat with a good friend. So that's where the coffee comes from. I know a lot of us who work in healthcare are avid coffee drinkers, and so it's just a coffee theme in my entire life. All right, now we're going to talk about the next thing I want to talk about. Now, we got coffee out of the way. I wanted to talk about a skill that I believe is critical for leaders to develop, that they truly want to cultivate a healthy work culture. And that is, drumroll, being able to give and receive feedback. First we're going to talk about why giving feedback is so hard. We're going to look at it from the perspective of the givers and the receivers. So, givers, you're the boss, and you need to give constructive feedback to somebody on your team. Why is that so hard for you to just sit down and have an honest conversation with them? It's because there's psychological reality that exists in all human beings, and that is, we avoid pain. Giving someone constructive feedback might potentially be painful. So what do we do? We avoid it. The reason that it might be painful for us is we don't want to hurt their feelings. Especially, did you ever give constructive feedback to someone, and they're like, Okay, what? And then you see the look on their face, and you can see it. Sometimes, they get emotional. Okay, there are times with this that people get very defensive, they'll get angry, they'll blame other people, and they may go on some type of attack. Depending on how they react, we actually then step into our fight, flight, freeze, or fawn mode as leaders. Okay, so, and actually, anyone who's giving feedback, if you get a negative response from someone, we tend to go into that adrenal gland releasing adrenaline and cortisol response. We all know what fight, flight, and freeze are all about; we know why that happens. I want to talk a little bit about fawning. I never heard of that. There's a fourth f. I never knew that there was a fourth f until about a year ago when I was talking to someone about a conversation I had with somebody that left me very frustrated, and I didn't know how to handle it. And they said, Oh, you're a fawner. What do you mean by that? So, I've learned a lot about what fawning means. Fawning is really an attempt to diffuse negative feelings or a negative situation by actually minimizing the feedback that you're giving someone. Like you may say, Okay, you'll shift it to a positive focus. You might say, But you do this really well. No, no, no, it's okay; you do this really well. Or you'll find a way to side with that. Well, yeah, yeah, you're right, you're right; we have been short staffed or you're right. You'll find a way to to actually side with them. People who are people pleasers tend to fawn when faced with a negative reaction. I am a huge fawner, and as I was preparing for this episode, I was actually thinking about when I was in college, and I met a boy in class my freshman year, and he was my boyfriend for a little while, and then I found out that he was with all these other girls, too. I remember going to the fraternity house, music blaring, beer all over the place; stunk as a lot of fraternity houses do, especially in the basement. And I remember standing there breaking up with him, and he was upset. So I'm like, You're a really nice guy. And I remember hugging him saying, Okay, can we still be friends? And I don't want to be friends with you. You're a jerk. But I started my fawning way back when, and I didn't realize it then, but I realize it now. So pay attention when you're giving someone feedback. If they react in a negative way, are you trying to diffuse those negative, your negative emotions and their negative emotions by fawning, trying to be nice to them? And here's the problem with that: you're going to lose credibility as a leader if you do that. You just got to stick to the facts, okay? Let them know. This is not okay. This is what I need to see from you in the future. If you need help, I can help. But try to avoid doing that sort of circling of fawning. All right, let's talk about being a receiver. Why is it so difficult to receive feedback, constructive feedback? I don't know, some people even have a hard time, I know I'm one, even receiving positive feedback. We downplay, Oh no, that was nothing or okay, but that's a whole other conversation. But why is it so difficult to receive constructive feedback? There's another psychological reality. No kidding. And that is, every human being gets defensive when on the receiving end of some type of negative feedback, even if they don't act on it. You understand that? Even if they don't act on it, they get defensive. And your brain responds to negative feedback and actually sees it as a threat. And that's why we react. Again, a lot of people react outwardly, but if they're not reacting outwardly, they're reacting inwardly again, even though they might not say anything. Do you ever give somebody feedback, and they're like, Okay, mhm, yeah sure, no problem, mhm, mhm. And you're thinking the whole time they're like, Oh, heck no. Okay, or oh. You think you're so perfect and blah blah blah. Some people won't react on the outside but they're reacting on the inside. So you just need to know that. And even when getting negative feedback or giving it, sometimes you just have to allow someone time to process. So, if you're on the receiving end of critical feedback, give yourself some time to process it before you react, okay? And sometimes what we find is people come back after and say, you know what, I really gave this some thought, and you're right. So how feedback is received is also dependent on two different things. One is what do they think of you? Okay? Do they trust you? Are you credible? Do you deliver feedback with good judgment, okay? Are you skilled at giving feedback, or are you all over the place? I'm actually still working on how to deliver constructive feedback. I teach this and I'm still working on it, and every now and then I'll say to someone, Look, I'm going to tell you this, I'm not sure it's going to come out the way I want it to. I care about you. We're going to have this conversation. And this is something that I'm still working on, being able to deliver constructive feedback in a way that is well received, and it makes me credible as a leader. So there's a lot riding on this. Do they trust you? Do they think you're skilled, credible? The other sort of dependent thing is how they feel you treat them. Okay? This is prior to giving them this feedback. Do they feel that you appreciate them? Do they believe that you care about them? We're going to circle back on this a little bit later. Do they believe that you want them to be successful, or you just giving this feedback to show them who's boss, or to make an argument, to win an argument, or to make a point? Okay, so why are you giving this feedback? Do they know it's because you want them to be successful? Because wouldn't you agree that it's easier to receive feedback from someone who you think cares about you, who wants you to be successful? Think about being on the receiving end of constructive feedback. It is way easier to receive that feedback when you trust that person has your best interests at heart. And I remember, so I started this company 13 years ago and I needed to have a website. Okay? I actually met my first web designer on an airplane. Okay, I was doing some interim leadership work, and I would travel back and forth from Washington, DC to Pittsburgh. And the one time I hopped on a plane and there was no room in the overhead for me to put my carry-on, and I did not want to check a bag. So, checking a bag for me is like the kiss of death. Okay, I do not check a bag because God forbid you get stuck somewhere if you have a connection. You won't be able to get on another flight if you've checked a bag, or let's just say it's very difficult. And my dad worked for the airlines his whole life, so I am a seasoned, okay, expert traveler. I know all the rules and regulations and the tricks and the tips. So, if you ever need travel tips, let me know. But I remember getting frustrated. And where I was sitting, there was a guy in the, it was a two-seater. It was a small plane. His name's Randy. And he said actually, it was where I was sitting too, he says, actually, I think I might be able to fit your carry-on underneath the seat in front of me, and he did. I was so thankful because I didn't want to have to wait for my bag. Randy and I started talking. He lived in Pittsburgh two. He was doing some consulting in DC, and he said He does web design on the side. So, I hired him, and he built my first website. And then after a while he said, You're too high maintenance, you need to get somebody else. And then, actually, Randy and I are still friends, like, he's a great guy. I asked my two best friends to come over one evening and I had wine, I had food because I wanted to reveal my website. I was so excited. While I'm watching them look at my website, I'm all excited like I'm a real live boy torpedo. I'm live. And my cousin Dina, one of my best friends, she stood up, she put her hands on my shoulders, and she said, Renee, you know I love you. I said, of course, I love you, too. She said, I want you to be successful because we keep talking about, I'm going to have a beach house in Maui, and they were going to have their own en suite and everything. Okay? That has not happened. They're still waiting. She said, I love you, but I hate your website. I felt like I got punched in the gut initially, and I'm like, what? And she says, what is this? It looks like you're selling home interiors. You have flowers. You have all this fluffy stuff on your webpage, like your home page. Where's you? You're trying to be a speaker. I don't even see a picture of you. And I looked over at Kim, and I said, Kim? She's like, Yeah. It sucks. Okay? I'm like, oh my God. But you know what? They were right. And because I trusted them, because I loved them, they loved me, I was able to see through their eyes and receive that feedback, and I changed it. And obviously, I've changed it many more times. But to make a point, it's easier to be on the receiving end of feedback if you trust that person cares about you. If you trust that they truly want you to be successful. Okay, let's shift a little bit on how you, as a leader, can actually create a culture of ongoing and relentless feedback. One of the most powerful things that you can do, and it's one of my very practical strategies, is if you want to create a culture of feedback, you have to give other people permission to give you feedback first. Here's what this would look like. Let's say you're the manager of a neuro stepdown unit. That's my comfort zone. That's where I came from. And let's just say, there's interdepartmental conflicts between your department and the neuro ICU. Here's what you do. You go to the manager of the neuro ICU, and you say, I want to work on improving the relationship that we have between our department and your department. If I or anyone on my team ever does anything that you or anyone on your team finds disrespectful, they miss something, they don't do something right, I want you to come and tell me first. And I promise you two things. Number one, I promise I'll be open to it. I won't be like, Oh, you think you're perfect? What about your people? Blah blah blah. I promise I'll be open to it, and I promise I'll do the same for you. This is how it works with your teammates, okay? The people who work on your team. Let's say, I work with you. Your name is Lori. And we're peers, staff nurse and staff nurse. I say, hey, Lori, if I ever do anything that you find disrespectful or if I've missed something or if I've made a mistake, I want you to come and tell me first. And I promise you two things. Yep, that I'll be open to it, and I'll do the same for you. That's how you establish peer-to-peer feedback, because what will happen is you make a mistake, you treat someone with disrespect, it's either your department versus their department. Everybody's talking about it, but they're not giving the feedback. So they may complain about you, but then nothing ever gets resolved, does it? It just ends up being this sort of gossipy, indirect communication that destroys relationships and impacts the very care that you're all providing. So, number one, give people permission to give you feedback first, and it works with your team. So here's the next practical tip. If you ask your employees, Hey, give me some feedback on how I am as a leader, that's way too vague. Your brain does not like to spend any energy. It only wants to spend energy on the things that it has to. And when you ask such a vague, broad question, it's too big. It's too much. You're not going to get feedback. But if you say, what's one thing that I can do better? And you might even want to further include some type of topic. What's one thing that I can do and how I communicate with you? What's one thing that I can do as far as rolling out changes or processes? What's one thing because everyone can come up with one thing? I asked somebody on my team this because we've been doing these check-ins. Okay, what's one thing? What can we do better? And I'll just say it like that even that's not how it's written, but if it was. And they're like, Oh, I don't know, I'll think about it, or oh, everything is fine. I'm like, Oh no, tell me one thing I can do better as far as how I'm communicating with you. And this person thought of it and said, Okay, when you send me an email with something, I always feel like it's urgent. So I do it right away, but then it sometimes interrupts something else that I'm doing. It would be helpful if you added a timeline. Hey, I need this by, or Hey, this is no rush. Or is there any way you could do this now? I'm like, perfect, okay, end of story. Everybody can come up with one thing, but you have to make it easy for them to do that. The other thing that I would include is what's one thing I'm doing well in how I communicate. Because there's a lot of things that you're doing well. And how do you know that your team appreciates that if you don't ask the question? So again, one thing that I could work on, one thing that I'm doing well and ask everybody on your team that question. All right, let's shift a little bit and talk about how to develop a culture of peer-to-peer accountability, peer-to-peer feedback. Look, we give feedback here. And it starts with you setting an intention for feedback. And this intention needs to be peppered throughout your entire career. Okay, in your department, you start by saying, In this department we give and receive feedback in a way that helps each other to learn and grow, part of our continuous improvement. The best time to start doing this is when you're orienting new people. And there's something that's happening out there. It's been happening for a long time, but it seems like it's getting a little bit worse. And that is where you hire new people. They have a preceptor. The first time the preceptor gives constructive feedback, they pulled up my preceptors the bully card. And I've talked about this. We talked about this. I think in one of the last solo episodes I did on preceptors, and actually, we'll put a link to the show notes, a link to that episode in the show notes. So very common, actually, just had a coaching call yesterday with someone who said they just lost a new nurse. The new nurse said she was being bullied by her preceptor. And you have to ask the question, Is that true? Is the preceptor really bullying that new nurse, or was the preceptor giving constructive feedback, and this person didn't like it, or was struggling with it so quick because it's uncomfortable? Okay, so here's what you do. You tell your preceptors to say this to their orientees, day one. My intent, remember, everything starts with intent, it's to help you to be a successful nurse, successful respiratory therapist, whatever it is, fill in the blank. And this is what success means to me. So, this is what I used to say to new nurses as I was precepting them. I would say, I want you to be the type of nurse I want to work with at 2:00 in the morning in a crisis situation. We don't have anybody else but yourself. And I want you to be the type of nurse that I would want caring for my precious family. And in order for me to do that, for me to help you to be successful, I'm going to give you a lot of feedback. I'm going to tell you the good, the bad, and if I have to, I'm going to tell you the ugly, and I'm going to need you to be open to it. And then every day that this person is working with that orientee, at some point towards the end of the shift, say, Here's one thing you did really well. Number one thing, here's one thing I'd like you to work on. Everybody has something to work on, but you bake it in. This is what we do every single day. We bake it in. So, set that intention and orientation. And guess what? You need to be having the same conversation without orienting when you meet with them. Hey, how's it going? You're getting the feedback? Yeah. Because that's what we do here. We give and receive feedback. You also need to do this when you're having any check-ins. As I mentioned, we do quarterly check-ins with the people on my team. We check in what's going well, what's not going well, what's one thing we can do better, what do you need? These are just, it's a really great opportunity. It forces you to sit down and give each other feedback. And then any time there's an incident, and you know what I mean by an incident, within 72 hours, that's the best time frame, because that's when people's memories are more accurate. Anything after 72 hours, people forget, and they make up stuff. Okay, not intentionally, it's just the brain gets fuzzy with details after 72 hours. But it's to sit down with them and say, Okay, what happened? Tell me, this is what I heard. Tell me what happened. And then that's when you're going to give that feedback, okay? This didn't happen, right? You didn't do this right. Whatever that is. Here's the expectation when you need from me to help you to achieve this the next time. If you haven't set the intention for feedback already, set it now. Because as we continue to ride the wave of complexity in healthcare right now, being able to give or receive feedback, like I said, it's a super skill that every leader and their teams really need to, you need to develop. And there's a way that you can do this. I think that makes it even easier with another roadmap. And people who know me, they know that once I read a great book or once I read an article, I'm famous for reading an article in the Harvard Business Review, and that becomes my mantra forever. I have a lot of that. I read something that resonates with me, and I'm like, Oh my God, I have to share this. And so what I have found to be super helpful is this concept of Radical Candor. Now Radical Candor, and I've got my book right here, was written by Kim Scott, and she, will have the link to this in the show notes, too. But the whole concept of Radical Candor is about caring enough about someone personally to tell them the truth. I've talked about this many times. We avoid telling people the truth because for a lot of the reasons that we just talked about. And because of that, people are walking around in your department right now not even knowing that they're perceived as disruptive or that people dread giving them report because they know they're going to be nitpicked to death. We've, we see more bullying and incivility in healthcare because we've normalized deviant behaviors. That's just the way they are. And I often think has anyone actually sat down and had an honest conversation with them about their behavior? Chances are they have not. So Radical Candor is caring enough about someone to tell them the truth. It's about being clear, and Brene Brown talks a lot about this. Clarity is kindness. Being clear on expectations is the kindest thing that you can do for someone is being super clear, and it's about being willing to tell the truth, even if you're uncomfortable. Okay, even if it's uncomfortable, have the conversation anyway. And I know myself, what I tend to do is if I have to give some constructive feedback to somebody, I put my bullet points like I actually write them down. What do I want to cover? What, why am I giving this feedback? Okay? Because I actually learned this from my business coach who said, When you're giving someone feedback about their performance, let's say their performance isn't up to par, you have to tell them when it's not up to par, what happens? Like, why is this a problem? Sometimes we forget to tell people, why is this a problem? Okay, when you don't do that, this is what happens to me on the back end, or this is what happens to our team or our patients. Like you got to, What is the impact of not meeting expectations. Even if it's performance, it's a great way to say, Here's the impact. And then being able to give people that space to think about it and then say, Okay, what can you do? Because if you don't tell them this, they're not going to know. They're going to continue doing what they think is right. Again, clarity is kind. Being able to give them that feedback even though you're uncomfortable. And the reason, like I said, that I write things down because, remember, I'm a fawner. And if I at least have a plan, if I have a plan that's written out, it helps stop me from fawning. So you have to think about your reactions when you're giving somebody feedback and you fight, argue with them. You too do this, I have a videotape of you doing this. What do you mean that's not you? Are you a fighter? Do you freeze? Do you run? Okay, let's end the conversation, bye! Or do you fawn? But sometimes, having that written plan can really help you to control yourself. And knowing that it's so uncomfortable for most human beings to be on the receiving end or the giving end of some type of constructive feedback. So you've got to help us out. So just think in terms of adopting a Radical Candor mindset, always think I care enough about you to tell you the truth. Now, it has to be true. Do you care enough about them to tell them the truth? Because it starts there, and I hope you do. All right, so as we wrap up, we talked about coffee, of course, and we talked about being on the receiving and the giving end of feedback and how it's a skill that you really need to develop as a leader. I've given you strategies for yourself to receive feedback, and I've given you some strategies to actually help your team receive feedback and give feedback that peer-to-peer accountability. And just we actually have, it's our skill development. We have an online program that has right now 12 topics. Giving and receiving feedback is one of them. I'll put a link in the show notes. It's basically you get an article about feedback. You get an activity. I love this activity. It's called the Hot Seat Activity. It's very powerful. There are tips on how to give feedback. There's some scripts in there. There's memes about giving feedback. And there's a little short video from me. So again, it's like done for you. Here you go. If you want to start educating your team with the knowledge and skills, and tools that they need to actually start giving feedback. But all of this starts with you as the leader. All right, wrapping up, I want to thank you for being here. I want to thank you for either listening or watching and for doing your part to cultivate and sustain a healthy work culture. We have really important work to do, and I'm glad you're here learning the skills and tools that you need to actually lead your teams. If you like this podcast, please give us a rating. I'd love a five, but don't lie, okay? Be honest. Can't talk about radical candor, or if I'm going to tell you, Give me a five even though you may think it's a one. I hope that's not true, and I hope if it is, you'll let me know why so I can get better. But if you can post a review, that would be super awesome. And of course, share this with someone else who you think may need to learn a little bit more about how they can cultivate a healthy work culture. So, thanks again for being here and for doing your part to address bullying and civility in healthcare. Thanks, everyone. Take care!

Renee Thompson:
Thank you for listening to Coffee Break: Breaking the Cycle of Bullying in Healthcare – One Cup at a Time. If you found this podcast helpful, we invite you to click the Subscribe button and tune in every week. For more information about our show and how we work with healthcare organizations to cultivate and sustain a healthy work culture free from bullying and incivility, visit us at HealthyWorkforceInstitute.com. Until our next cup of coffee, be kind, take care, and stay connected.

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