You're listening to the P.T.
Pinecast,
where smart people in health care come to
make noise.
Here's your host, Jimmy McKay.
Rebecca Griffith is back.
Off script,
I believe we're going with the name of
this right now.
We promised last time that we were going
to talk about something.
I'm glad you remembered what it was
because as people may or may not know,
I talk about a lot of things.
By the time we get back to talking
about the thing we promised, I forget.
So what was it?
We brought up a topic towards the end
of last conversation and it was a good
one.
Yeah.
So last time we talked about negotiation,
but one of the other things that people
have been asking me about,
because I talk about practicing at the top
of your scope all the time.
And so people will message me and they'll
say, hey,
I really want to practice at the top
of my scope,
but I can't because of barriers at the
place where I work.
And those barriers seem to be like policy
changes and decisions coming from
administration that don't seem very
clinician-centered or clinician-focused or
patient-centered or patient-focused.
And these clinicians are having a hard
time advocating because they feel like
when they do,
they're being labeled as problematic.
They feel like they get in trouble.
They feel like things are punitive.
They feel like clinicians aren't included
in decisions.
the policy changes at the phase where they
should be where that input would be
valuable and then they just have these
policies thrust on them and they feel like
they just have to smile and continue on
even if they disagree so we were going
to talk about how do you have those
conversations with your leadership team is
there a better way to understand where
those decisions are coming from and how do
you bridge the gap between like us versus
them
Yeah.
So I know I have worked in very,
very structured organizations,
like large organizations and also smaller.
There's some structure,
but maybe less structured organizations.
And this happens in both of those things.
So I feel like we need to give
advice for like super structured.
I'm thinking like hospital system routes.
And also smaller organizations,
some structure,
but maybe a little less structure.
What do you do in those situations?
When you said that person gets labeled
difficult, you know that's me.
And I figured out why that is.
We talked about this a little while ago,
the six types of working genius.
And once I figured out what my two
strengths were, my two working geniuses,
wonder and invention,
I love, well, I ask questions,
but the purpose is to figure out why
are we doing that?
And I understand because I've been in
leadership
and other people have asking a lot of
questions,
I can see how that gets frustrating.
So I've been on both sides.
So I try to sort of temper my
amount,
the volume and the speed at which I
ask questions.
And when, like right in the meeting,
maybe that's not the best time.
Maybe it's time for a pause and talk
afterwards.
So let's go with super structured because
you work in a lot of like very
structured hospital systems or help people
do that.
What are the best things to do?
Well,
I think one of the things that I've
realized over the last several years is
that like as a clinician,
you feel very much like don't infringe on
my clinical judgment and I'm here to help
patients and you're taking away my
autonomy.
And in large organizations,
I feel like it does feel like that
when they're trying to standardize across
a large system.
So it does can feel like that.
But the thing that I remind myself is
like,
The leadership team is not really there to
advance practice physical therapy.
They're not there to make sure all of
their staff are happy.
Like their goal and your goal, really,
if you work in a large organization like
that,
is to advance the mission of the hospital.
and so they're looking at ways to do
that and i think if you can see
that where that like what they're bringing
to you how does that advance the mission
of the hospital it may not advance your
mission as a clinician so i think leading
with curiosity and we talk about this a
lot curiosity and not criticism because i
think we also get defensive very quickly
And our immediate response is to be like,
what?
Are you kidding?
And I think like backing off from that
and being curious and saying like, hey,
can you help me understand the goal of
this policy?
How does this align with the hospital?
And how does this align with our ability
to provide patient care as physical
therapists?
Sounds like you're trying to quote Ted
Lasso, which is be curious,
not judgmental.
I have never seen that show.
You?
Oh my God, really?
From what I know about you,
I figured you were a...
Lasso head or whatever.
No,
I don't really watch a lot of TV.
So I'm like pretty outdated on all of
the shows.
So,
but I have seen that clip where he's
like playing the darts and, you know,
and we talked to our kids about that
too,
like with their interactions with other
people, curiosity, not judgment.
But I think it's,
In this case,
even curiosity and not criticism,
because I think our default reaction is
just to be immediately critical without
really understanding all the work that
goes into a leadership decision,
particularly across an entire health
system.
The person who cuts you off in traffic.
did not cut you off in traffic that
person has no idea or is a jerk
yeah it is not personal um the decision
being made hopefully came from a place
that they took into consideration lots of
different options and this is the decision
so first it sounds like you're saying take
a breath this was not made
for you right this was not personal and
try to under that seek to understand and
not to criticize
And I think the next part is just
like really, truly listening,
understanding the goal,
understanding why that decision was made
and then understanding how is it really
going to impact you?
Is this actually like,
it feels very impactful.
It feels very heavy,
but is it actually going to impact you
and your ability to provide care?
Does it change anything?
And if it does,
and if there's actually going to be a
problem, once you've calmly assessed that,
I think just saying,
are you open to feedback about this
process?
I have clinical concerns.
Okay,
so that moves to like sort of my
first suggestion,
which would actually be lead with a
question, large structured organizations,
smaller organizations,
that maybe you could ask this question
before a decision is made,
either upon hiring or later on in your
career, which is, hey,
if I have questions or concerns,
what's the best way to find out more
information about them?
Do you want me to raise my hand
in the meeting?
Or is that not...
because we've all i've at least i'm
assuming you have been in that meeting and
now it turns into like the town hall
but the town hall outside of like
frankenstein's yeah you know uh cottage
which is pitchforks yes and once somebody
breaks the seal right so like i'm all
for asking questions early and often but
the question also has to be so what
someone taught me this ask yourself these
three questions does this need to be said
Does this need to be said by me?
Does this need to be said by me
right now?
And if the answer is yes to all
three, by all means.
If the answer is no to any of
those three, then either no, not you,
or not you right now.
And I would even go with a fourth,
in what way?
So like, does this need to be said?
Does this need to be said by me?
Does this need to be said by me
right now?
Does this need to be said by me
right now this way?
And typically in the middle of a staff
meeting, when the change is announced,
that ain't the place.
Yeah.
Unless they ask, unless they say,
But again, I typically would default to,
hey, what is the best way to...
Can you talk me through this?
Again,
because managers are people and systems
are just people connected.
What's the best way for me to do
this?
And I feel like...
that at least reduces the opportunity for
someone to label you as difficult.
It's like, I did the thing,
you told me to come this way.
I'm actually trying to engage.
The funny part is I think the person
who like,
the type of person who wants to find
out why are we doing this?
What is this going to affect?
It's typically super engaged.
The person who's checked out is like,
all right, whatever.
Whatever, yeah.
They're like,
you could lose that person who is engaged.
You could turn them into someone who's
disenfranchised and that isn't the goal.
But I think the best way to lose
that person is to make them feel
psychologically unsafe after they ask a
question.
Oh, totally.
I've been that guy.
Yes, yes.
And they're like, hey,
help me understand this.
I have some concerns about this.
And then there's a punitive response.
I think that's a really good way to
like completely lose that person.
I've been that guy.
Oh, I have an open door policy.
And whenever you want to ask a question,
then I do.
And then, hey, listen,
seventy percent of communication is
nonverbal, said someone.
I know when I'm
Being told to ask a question,
but when I do,
I'm being told to stop asking questions.
And when I do and I feel that,
good luck getting me going again in a
good way.
Like, all right, I'm out.
I think it's also helpful to understand,
is that decision already final?
Like,
is it something we're considering or is
this a done deal?
And all I can do is ask clarifying
questions.
And when they ask,
are you do you have any questions is
a very different question or a different
statement than do you have any feedback or
comments?
Those are different things.
I did not understand this until I made
my career change to physical therapy and
started going to conferences and then
realized that there was a whole meme
behind what you just said,
which is after someone says something
clinically, non-clinically,
gives a presentation,
panel doesn't matter.
And then they open it up to the
floor and there's microphones around the
room.
And then the meme or the cliche is
sort of,
This is less of a question and more
of a comment.
Actually, it's all comment.
And that's not what we...
If you didn't ask for that,
not the time, nor the place,
nor the way.
I think that's also a good way to
put your foot in your mouth.
I heard this the other day that made
me feel very you.
And I wrote it down, which was...
When someone asks you a question or brings
you a problem or is looking to interact,
they're looking for one of three things.
And your job is to figure out which
one of those it is or even ask.
That's a way of figuring something out.
And then understanding if you can deliver
that.
And the three ways were,
is this person need to be hugged, heard,
or helped?
So hugged would be more like,
I'm going to commiserate with you.
Like, that's not okay.
I understand how this makes you feel.
Like sometimes some people do not need
that at all.
Some people are seeking that,
might not know it.
Heard would be like,
you just needed to vent it and you
needed to vent it to a human.
Yelling about it in your car is not
enough.
I agree on that way too sometimes.
And then helped is,
are they actually coming to you to have
you help them fix it for you to
fix it?
What is the reason that they're bringing?
So this feels like the person in
management will assume that the management
person is bringing that decision down.
The management person should take this
sort of triple H approach, which is,
does this person just need to be hugged?
Does this person need to be heard?
Or does this person need to be helped?
Are they looking for you to change it?
And then your response comes off of that.
Because sometimes just be heard.
Like, okay, your concerns are heard.
I see that.
And then they're okay with that.
Some people,
that's all they're looking for.
The hug is like, hey, man, I commiserate.
Like, that's not, you know,
and then I'm here because I disagree and
I want you to change it.
And I'm like, okay,
but I can't because that's the decision
that was made above me.
Don't kill the messenger.
But like,
I thought I found that was interesting
that someone said,
Because this works in lots of
relationships.
Sometimes I just want to say stuff and
people are like, well,
how do we fix it?
I'm like, I don't need you.
I'm not like,
that's not what I'm here for.
I don't need you to fix it.
I wanted to vent it.
Now that I'm vented, I'm good.
I think the other thing we forget is
that I definitely have learned as being
part of a board is that once the
decision is made,
you might not agree with that decision,
but you still have to go out and
present that and own that and carry that
and implement it.
So I think we forget about the humanity
of the people in leadership, too.
They may not even agree with the decision
that's been made,
but it's still their job to implement it.
And I think we put them in the
middle
unfairly because obviously we're not going
to go five levels above them and start
screaming at that person.
We would never, right.
It's almost like when your kids are like
meaner to their parents than they would be
to their teachers.
Cause there's like different layers there.
And I think sometimes we just kind of
go after our management team because we
disagree, but they might too,
but they're not allowed to like,
show that.
So I think just having grace with the
people in leadership as well.
It's not personal.
They're not doing it at you or to
you.
I agree.
I think people
I think sometimes the most engaged people
need to hear that because they're so
engaged and they feel, I mean,
I'm even using that word,
they feel connected and they feel that a
direction might not be the right way.
And it's hard for,
I'm saying this from experience,
hard to disconnect the decision from your
feeling because you're like, no,
this is not the direction,
but there's also ten other people around
me on a board.
And that's how decisions are made at large
organizations.
And if you don't like that,
go start a one person organization.
But then you lose the things that you
get with a larger organization.
Yeah.
So I think what's the biggest what's the
bigger picture?
How does this align with the organization?
Not necessarily my role in the
organization,
but how does this further the mission of
the organization?
Why was this decision made?
This is impersonal.
What is the best way for me to
communicate about this?
Is this actually impacts me?
Is it worth it?
And then how am I going to talk
about it?
Yeah.
Is this as bad as I think it
is going to be?
Or is this even actually what I think
this is?
I heard a guy speaking the other day
that said,
one solution to misinformation is
typically we share too much at one time.
Just want to give everybody everything.
And the guy really put it in great
perspective.
This was Donald Miller.
He said,
would you ever communicate your next seven
chess moves all at once?
It's like, well, no, it's like too much.
Even Martin Luther King said,
you don't need to see the whole staircase.
You need to see the next step and
know that you're going in the right
direction.
That's the direction you want to go in.
So I think that happens a lot where
here's the nine things that we're
changing.
And that person is trying to digest nine
changes.
Gosh,
we don't like a little bit of change,
never mind nine.
And I find that in large organizations.
Knowing that nine things by a large
organization need to be decided,
but does it need to be said?
Does it need to be said by me?
Does it need to be said by me
right now?
Does it need to be said by me
right now in this way?
And a lot of times it's TMI.
It's too much information.
Not because you want to keep people in
the dark,
but because they can't digest some of
those things.
It's hard.
Yeah.
She always says,
think of it like toothpaste.
If you,
can you put the toothpaste back in the
tube?
You cannot.
I've tried.
Like imagine like squirting out an entire
tube of toothpaste.
Could you put that back in?
And so do you like think about your
words, how you think about toothpaste?
Because if you can't get it back in
the tube,
so that seems to work well with like
children as an analogy about how you
should use your words.
Yes.
I think very good communicators are good
at communicating.
They're also pretty good at thinking about
what the audience will think, feel,
do when they hear a message.
And before they send that message,
they change the message to say,
now taking into consideration.
I mean,
know your audience is so obvious and
basic.
Yeah.
know your audience and how will they
react?
Does that change your message?
Of course it should.
You would say something one way to your
children as you would communicate it
differently to a coworker.
Same thing, different audience,
different message.
But a lot of times,
how we communicate where,
when is sort of my preference.
I'm going to send an email to all
staff because I want to be as efficient
as possible.
And I'm going to give you the entire
plan, copy paste and good luck with it.
And that ain't how brains work.
No.
That's a giant game of telephone.
We know how that game goes.
Fun game to play in third grade.
Good example.
Funny game.
But if you understand that that is a
good example on how information spreads
well or poorly, not great.
Yeah.
I think alignment,
which we talked about last week.
How can we all be aligned on something?
What are the barriers to that?
So at a large organization like a board
or a hospital system,
what would you tell the sender one thing
to do different to improve communication?
And what would you tell someone who's in
the audience to improve receiving
information?
Realistically, if I was the sender,
I would probably find my most difficult
person, quote unquote difficult,
my most engaged person that I know is
going to be the first one out of
the gate, like upset,
complaining about it, has feedback.
And I would practice it with them because
then you're making them feel engaged.
You're making them feel important.
You're getting that knee jerk reaction
immediately in a smaller setting.
And then that can help you tailor your
message when you go for the big group.
So I think there's probably different
categories of people.
I would get your like people who are
always going to push back your people who
always kind of accept things without
saying anything.
And then your people who are sort of
like somewhere in the middle that are
always like sort of more positive,
more optimistic,
like your innovators and like,
I would do a dry run with those
different people and to say, Hey,
I want to get your take on this.
And then when you go to the bigger
group,
you have a little bit more sense and
maybe you've,
gotten some of that pushback and figured
out how to address it so that it
doesn't blow up and you don't have staff
like complaining to each other and
everybody kind of bringing morale down.
So you mean actually take that person who
might be the most, quote,
difficult or labeled as difficult and
actually bring them into sort of the team
of messaging.
That's cool.
When you first were saying that,
I thought you were saying picture that
person and how would you communicate to
them.
No, I just run it.
You're saying actually, hey, can we meet?
Listen,
there's a change coming and I've got to
communicate it.
Let's talk it through.
And I value your input and I would
like to have it before we do this
presentation.
And that person does want to be,
as Oprah has always said, seen, heard,
and understood.
Yeah.
And now, you know,
it's a sneaky good way because if you
can make that person,
I don't want to say happy,
but if you can craft a message where
that person understands in a good way...
Um, who can't you improve?
When I've,
when I've worked on technology adoption,
I'm like,
give me three really forward thinking
people to test this out for two weeks
and give me three people who you think
are going to hate this.
Yeah.
And if I can, I mean,
obviously like the layup is the people who
are forward thinking and early adopters,
but man,
what would happen if I can make the
people who are crusty and don't want to
do things and hate change,
I can make them consider it and actually
almost like it.
Is that a good, is that,
is that a good bit of information?
That's what I would do.
And then how about from the other side?
So that's what a sender would do.
What would you tell people,
which is more people?
More people are going to be in the
audience of hearing.
Is there a step?
Is there a thing or a couple of
things which is like, first, exhale,
reread the thing or redigest the thing,
right?
Or what else would you tell them to
do so they can be better parts of
the team?
I think listen for the bigger picture.
not just how this impacts you but how
is this going to impact the system because
that's that's realistically why they're
doing it they're not doing it because of
you and then write down your questions
And then when you're feeling calmer,
reread them later.
And then maybe ask what the best way
to ask those questions is because I'm not
going to lie.
I'm obviously that person that raises my
hand and I'm like, well,
I don't feel like,
like I am that person, obviously.
I'm that person with the whole profession.
So I feel like I,
I have learned that I need to take
a minute.
I need to look at the bigger picture
and I need to take a breath and
you know,
You can be a positive hole poker,
but you need to make sure you're coming
correctly.
Yeah.
What is the goal of my question?
And I think a lot of people do
come correctly and they still are
corrected.
And I don't love that.
But I think just I can only control
what I can control,
which is how I'm receiving the information
and how I'm processing it and then how
I engage in that process.
Yeah.
I like to remind people that systems are
just a bunch of people connected.
When someone's like, this place...
I'm like, it's a bunch of people.
I know there is a building,
but it's people.
And the larger the organization...
the smaller that person is in terms of
like a part.
They're just a part of that, right?
So a lot of times that person is
just a messenger.
This was handed to them or they were
a small part of that decision being made.
So try to separate, again,
like going back to that analogy,
like the guy who cut you off in
traffic might be a gigantic inconsiderate
jerk.
That's a him problem.
But it wasn't,
he didn't cut you off because he saw
you in traffic and
It's not personal.
So removing that.
I can say that very,
very with a straight face because I am
guilty of that or have been and try
to not be now.
Yeah.
So that's my best big organization advice.
And I'm obviously a big advocate at
legislative advocacy, facility advocacy,
self-advocacy.
But I think we need to be mindful
of how we're doing it.
Understood.
Yeah.
I've said this before.
It was a parallel I saw when I
was in PT school.
And then going forward,
I feel like the analogy or the comparison
still holds up, which is frequency,
intensity, time, type, volume,
progression.
Those are exercise principles.
Those are also communication principles.
Giving someone one really big,
dense thing to understand.
Like, well,
I sent you the seventeen-page email.
What's the problem?
It's sent.
It's in there.
Per my email from last week,
that's not how we absorb information.
That's not how change is made, typically.
It's just not.
And the same as an exercise.
I did one really hard deadlift.
Where's the change?
I'd rather you do
Less difficult deadlifts,
but more of them spread out over a
time period.
The parallels for me are very,
very obvious.
Yes.
That when you see organizations or people
who communicate well,
the exercise is crafted for that patient.
The message is crafted for that person or
that audience.
It's done.
Frequency, intensity, time, type, volume,
progression over time.
Things like that land better.
work better.
And I always say,
the job of communication is not to
convince you.
The job is to achieve understanding.
So this is where you might have a
thing that you're saying in a meeting or
a board meeting or a staff meeting.
And the thing might be bad.
It might be.
What are we doing here?
My job as the sender is not to
convince you that this is a good idea.
The job is to make you understand it
and what it is.
I always move the goalpost closer to the
kicker.
The job is to achieve understanding.
Yeah.
That's it.
How about smaller organizations?
Let's say an organization of, you know,
five to fifteen people,
which is pretty small when you compare it
to other organizations.
Does it change at all?
Yeah, I think it does,
because you I feel like, you know,
the people more intimately,
like there's more of a relationship there.
So I feel like.
I don't know.
Maybe it feels more personal.
Maybe it feels more like it should be
a team decision in a group that small.
I feel like when you're that small,
when you're smaller...
So now I'm picturing the radio stations I
worked for.
Because we might have like five to ten
on-air staff people and then some support
people.
I rarely called an everybody meeting.
Because the things I needed to communicate
were different for each person based on
task and visibility and what they were
working on.
So with smaller organizations that I
worked in,
I tried to make them whenever possible
one-on-one because I could.
You can't do that in a hospital.
You might not be able to do that
in a large franchise of clinics.
You can't do it.
And keep in mind,
I was a small organization as a radio
station and asynchronous.
The morning guy was not there at three
o'clock in the afternoon.
So me asking him to stay an extra
six hours is mean and rude.
So when I saw my agility as a
small organization was,
if I had something to say,
I had no problem saying it eight different
times in a day instead of one time
to eight people.
I also crafted,
I changed the message based on the person
I was talking to.
Again,
that's something you can't do in a giant
hospital situation,
but you can do if the organization is
smaller.
And I feel like my adoption,
at least I gave myself a better chance.
Well, and I think too,
when you're in a small organization like
that as well,
when you're making those big decisions,
you can actually sit and say,
how is this going to impact Jimmy?
How is this going to impact Rebecca?
How is this going to impact Chuck?
And you can like really think about that
as opposed to like,
how is this going to impact the twenty
thousand people in this hospital system?
Right.
All right.
Let's keep this short today because we're
sort of winging this one.
What would your parting shot be for this
topic?
It's not personal.
It's really hard to remove that though.
Yeah.
Cause you're saying it to me and this
will affect me in some small or big
way.
So it is hard to remove the,
I mean, that's,
Yeah.
So I feel mine will be the same
thing.
It's not personal.
I had a really good angle a second
ago,
or maybe I'm just having trouble like sort
of communicating it,
which is this wasn't decided for you.
Yes.
Very rarely have the things that I think
are going to be a big, huge,
scary deal that end the world actually end
the world.
Right.
But I know in the moment when I'm
hearing it,
Gosh,
it sure feels like that to my core.
I remember there was a situation,
the radio station I was working for and
running had gotten purchased.
And I'd never been involved in a radio
station getting purchased before.
To me, it was like, oh my God,
the moving truck is going to come and
what happens?
And some people who had been there longer
than me were like, just relax.
They handed out name tags.
Like legit, like magnetic, high, you know,
twenty five dollar pop name tags with the
new company logo and my name on it.
And I was looking around going,
I'm not wearing a name tag, dude.
What's this?
And my boss who had been there through
changes was like none of it.
Oh,
and the other thing was vacation accrual
time had been changed.
So if you had like four weeks vacation,
if you've been there for fifteen years,
everybody was at two.
And that made people freak out.
And my boss was like, relax.
He's like, I'll explain.
And it turns out companies do that to
get people who've been there a long time
to retire early.
He's like, now let me...
So he did exactly that.
They did an all-person meeting,
communicated what the person above them
had told them to communicate.
These changes are going into order.
And he pulled me aside and he's like,
we're going to work around that.
He's like, Jimmy,
if you've got three weeks vacation,
you've been here for eight years on the
books,
you'll be out for two weeks a year.
And then we'll be here.
So essentially he was saying,
and he knew how to say it to
me because he saw my eyes in the
meeting.
Like,
I just earned my third week of vacation
after working here for six years.
He's like, relax.
It's not going to be as bad as
you think.
I think that is a good ending.
Like, relax.
It's not going to be as bad as
you think.
Right.
Yeah.
Again, I've brought this up before.
My dad's great advice too is always,
is the building... My dad was a fireman.
Is the building on fire?
And I'm like, no.
And he's like, then breathe for a second.
We'll figure it out.
As bad as it... Is anybody bleeding?
Is the building on fire?
If any of those answers are yes...
We have a problem.
The answer to any of those is no.
Okay.
I'm not saying what you're facing is not
important,
but we've got more time and we can
figure it out.
It's probably not as bad as you think.
We're not on fire.
We're not believing.
Those are good things.
Let's work it forward.
Rebecca Griffith,
what do you have coming up and what
do you have coming up?
What are you looking forward to?
Oh, goodness.
You know,
I am presenting at a conference at the
end of this month for emergency medicine
and rural indigenous communities,
which I'm really excited about.
That's fun for you.
I feel like that would be a step.
Hill Day is what I wanted to mention.
We'll be in person for Hill Day.
Maybe we'll do some short form videos.
That was my pitch.
I want to get as many people who
are going to Hill Day.
If I can get thirty seconds with thirty
of them.
why you go i feel like that would
get more people to go a year three
five so maybe we'll we'll meet we'll do
one of these live at hill day as
we're walking the hill perfect rebecca
griffith the eddpt thank you see ya
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See, Keith?
We read the script.
Happy now?