ABOUT THE AUTHOR Al Switzler is author of three bestselling books, Influencer, Crucial Conversations, and Crucial Confrontations. READ MORE BOOK A SPEAKER

  Dear Crucial Skills,

With the recent H1N1 scare, I would appreciate any advice on approaching colleagues in a healthcare institution—usually managers and MDs—to stay home when they are sick rather than feel obligated to come to work. I would also appreciate any advice on motivating them to get immunized against the flu without having to force them.

Fighting the Flu

 Dear Fighting,

The recent H1N1 situation illustrates the importance of motivating someone to do something they may not want to do.

What can we learn about motivation from looking at the situation where people are sick but feel obligated to come to work? As we discuss in Crucial Confrontations, there are a few key concepts that provide the foundation for this discussion.

Consequences Motivate. There are consequences that occur naturally, and there are consequences that are imposed or enforced by others. People make decisions to act based on the consequences they anticipate. As a result, motivation is personal because people see and anticipate different consequences. Almost subconsciously, people assess the positive and negative consequences that are most likely to occur and then they act based on those assumptions.

Help Others See Consequences. We can motivate others by helping them see both the obvious and the more obscure consequences. In your situation, this includes consequences to self, to coworkers, to patients, to coworkers' and patients' families, to finances, to reputation, and to the quality of work. When we help others see and feel the consequences, people can change their desire to act in certain ways.

So let's separate some of the issues in this case. For example, the manager is aching and coughing and trying to decide if she should go to work. What are the consequences of staying home? Positive consequences are that she will feel better physically. Sipping hot chocolate and lounging around the fireplace sounds pretty good. Also, she won't get anyone else sick. However, she's not sure she's that sick and she assumes the probability of getting someone else sick is fairly low.

Negative consequences include not getting paid because she has exceeded her paid time off. This is particularly glaring because she has several bills that are due. She will also miss two meetings because delaying them is impossible. Catching up when she returns will be next to impossible. And while some people might have bad thoughts about her coming to work sick, she can probably avoid these people. Even if she doesn't avoid them, they probably won't speak up any way.

The combined value of the anticipated consequences makes the decision easy. If she goes to work, she will get paid, get important work done, and it is highly unlikely she will get anyone sick. More importantly, no one will say anything to discourage her decision. Take note that for a doctor, the financial and productivity consequences might be even more costly and the likelihood that anyone would speak up to the doctor is almost nil.

So as someone who cares about the consequences of spreading germs, what do you do? Here is some advice.

First: Manage expectations as a group around not coming in when sick.
Excellent performance begins with clear expectations. When we make agreements, we often agree on the who, the what, and the how; but we would improve motivation if we focused on the why. Have a discussion about the reasons you are making this agreement and clarify the possible positive and negative consequences. Why should people not come to work when they are sick? Why should they get immunized? Look at it from the perspective of the sick person. What will they lose? What will they gain? What will happen to colleagues and patients?

In addition to sharing the facts, share real stories of what happened in your hospital. Share the story of the nurse who picked up a virus at work and passed it on to her mother who was now in the intensive care unit. Where did the problem start? Usually with colleagues who came to work when they were sick.

Also, talk about the financial consequences or about the trust that might be lost if a colleague makes a commitment. Helping people understand and feel the weight of both clear and obvious consequences helps them make more balanced decisions.

Second: Agree to hold one another accountable.
As a part of your discussion, agree to hold each other accountable and speak up to individuals who come to work sick. Part of that agreement should be that everyone will talk in a way that is safe and professional; they will try to understand and help. Speaking up and holding others accountable is not just the boss's job; it is everyone's job.

When we make agreements, clarify expectations, outline natural consequences, and feel able and motivated to speak up, we reap the benefits of having a crucial confrontation. The difference between good teams and organizations and the best teams and organizations is how rapidly and respectfully problems get resolved. Individuals in these teams don't let issues fester and they don't let issues destroy relationships. They quickly and respectfully put them on the table and reach a resolution.

Best wishes,
Al

related material:	comment on this article
vol. 4 issue 5: Confronting Medical Mistakes
vol. 4 issue 8: Talking about Change
vol. 5 issue 30: Creating a Culture of Accountability

	ABOUT THE EXPERT    Steve Willis is a master trainer and vice president of professional services at VitalSmarts. READ MORE   BOOK A SPEAKER

During my last trip to the United Kingdom, I found myself struggling to respond to what seemed like a simple question, "Blooming brass monkey weather isn't it?" Even though the person addressing this question was speaking English, and even though I understood each individual word, I was completely oblivious to what he asked. Even when the conversation continued, I was stuck on that phrase—struggling to figure out the meaning.

After this conversation ended, I sat down to prep for my class. As I reviewed my material, I saw a lot of phrases and expressions that had the potential to create the kind of confusion I had just experienced. So this month, I wanted to talk about teaching VitalSmarts material to culturally diverse groups.

I've found the best thing to do in these situations is to translate. I try to identify jargon and VitalSpeak—phrases and expressions we use to name skills or describe ideas—before the class starts so I can be prepared to translate them during the session. For example, when training abroad and talking about a Sucker's Choice, I might say something like, "We're now going to look at a Sucker's Choice, a perceived choice between two options that are both bad," and follow that with an example. At other times translating is simpler. In Influencer, one of the videos mentions Chex Mix. Before this video plays, I say, "Dr. Wansink is going to mention something called Chex Mix. Chex Mix is a snack made of dry cereal and nuts."

Then during the class, I've also found it very useful to have participants turn to a partner and summarize the main idea of what they've just learned. This helps them internalize the idea, and allows the trainer to clarify any misunderstandings. I've also had a lot of fun identifying local expressions and phrases for the terms in the material.

So good luck with your trainings, wherever you may be holding them, and always remember to "Eat what you can with your Grandfather's fork." Don't ask me what that means.

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