Dear David,

How does the Influencer model relate to processes such as: PDCA/DMAIC Cycles, Quality Circles, Statistical Process Control, Continuous Improvement/Kaizen, Lean/Six Sigma, and other Quality-Related approaches to Process Improvement?

Signed,
Curious

Dear Curious,

Welcome to the history of the Quality Movement! I’ve been lucky enough to work with many of the organizations at the forefront of this movement—Toyota, Ford, Mazda, Motorola, Xerox, and others—since the late 70s. My work has been mostly related to interpersonal skills, but it turns out these processes are also integral to quality improvement.

I think these processes help teams answer two important questions:

1. What should we do?
2. How do we get everyone to do it?

The first question focuses on process improvement; the second on influence.

PDCA/DMAIC Cycles: For those not already “in the know,” these initials stand for:

• PDCA = Plan, Do, Check, Act
• DMAIC = Define, Measure, Analyze, Improve, and Control

These processes are pretty similar. Each suggests a logical order to performance improvement initiatives, and each is intended to describe ongoing, continuous cycles of improvement. If you follow the steps in order, you should arrive at the answer to “What should we do?”

Quality Circles: Quality Circles were an early attempt to add Influence to the PDCA/DMAIC processes. The idea was to involve the people who were doing the work. If they were the ones who came up with the improvement idea, then they’d be more committed to “getting everyone to do it.”

These quality circles became the management fad of the early 80’s. Unfortunately, they were often imported into autocratic cultures that weren’t open to employees’ ideas, and so backfired.

Statistical Process Control (SPC): This is the approach that helped Japan conquer automobile manufacturing in the 90s. SPC focuses on how stable, predictable, and uniform a process can be and shows teams how to measure their consistency.

Before SPC, teams would achieve quality specs by producing 100 fuel injectors, and then throwing out the 20 that were out of spec. With SPC, teams could figure out how to make all 100 fit within the specs.

However, SPC required more arithmetic and math than many front-line employees would tolerate. SPC is great at answering, “What should we do?” but its use is often limited because it’s so hard to “Get everyone to do it.”

Kaizen, Lean, and Six Sigma: These three approaches are the basis for most quality programs today. Each tries to answer our first question, “What should we do?”

• Kaizen focuses on short-term, small-scale improvement projects. It is often used at a team or even individual task level. The tools it employs are fairly simple and low cost: process mapping and cause-and-effect diagrams.
• Lean focuses on intermediate-term, larger scale projects. These projects often span functions and departments, and include a wider variety of outcomes—quality, waste, speed, etc. It employs more tools and more sophisticated tools: visual controls, kanban, pull systems, etc.
• Six Sigma focuses on long-term, large-scale, and complex projects. These projects involve multiple stakeholders, complex variables, and multiple outcomes. It employs the largest number, variety, and sophisticated tools: statistical tools, value-stream mapping, and a host of others.

Influencer: When we created the Influencer model, we began with the second question: “How do we get everyone to do it?” Presupposing that the quality team had already discovered what the “it” was. For example, it doesn’t take a lot of sophisticated quality tools to discover that hand washing is important in a hospital. But it often takes Influencer, with its Six Sources of Influence™, to get people to do it.

This emphasis makes Influencer the perfect complement to many process improvement initiatives. Teams use Kaizen, Lean, or Six Sigma tools to find better processes and then use Influencer to motivate and enable their adoption.

The greatest overlap between Influencer and process improvement is in two areas: Vital Behaviors and Structural Ability. Influencer focuses on the few Vital Behaviors that drive Results. Often, we use quality tools, such as process-flow maps, to find them. In addition, we use Kaizen, Lean, and Six Sigma to change the environment to make the Vital Behaviors easier and more likely.

I hope this helps. Many, if not most, of our customers use a variety of process-improvement systems. And they find that Crucial Conversations, Crucial Accountability, and Influencer play a role in furthering their success.

Best,
David

Dear Steve,

As a nurse, I am responsible for precepting our new hires. In most cases, experienced nurses come to my unit and my job is to help them learn the policies and procedures unique to our unit and the hospital. The most difficult challenge is the “know-it-all” who is impossible to teach. We avoid these people in our personal life and regard them as arrogant, but how do I deal with someone with an unteachable attitude at work?

Signed,
Preceptor
Dear Preceptor,

Braggart, smarty pants, windbag, egoist—however you refer to this category of people, it still doesn’t change the fact that “No ones likes a know-it-all!” (one of my mom’s favorite sayings—just second to the all-time favorite, “Stop crying or I’ll give you something to cry about!”).

Most people figure they’ll just have to grin and bear the time they’re required to spend working with a know-it all. Or, when patience finally wears thin, they try to “help” the person see the impacts of their know-it-all ways. And while either the “grin and bear it” or “put them in their place” approaches might work in a social setting, at work, you can’t simply choose to avoid these folks. It’s your job to work with them—especially in your case.

My best advice to you is to change the way you go about trying to change these new nurse’s minds.

Typically, when we have information we want to impart, our preferred method is tell, followed by tell, and then we end up with, well . . . more telling. You get the point. Instead of starting and ending with tell, try to create an experience that will help them change their own minds. Here’s what I mean.

I asked my good friend, Jamie, who’s responsible for precepting new hires at Med/Surg Psych Forensics Unit if he’d ever been assigned to train a know-it-all, and if so, what he did. “Of course,” he responded, “I had one a little while ago. She was the toughest I’ve dealt with yet.”

She came to her new unit pre-stocked with all the knowledge, expertise, and information she needed for this new unit—at least that’s what she believed. He explained she had ten years of experience as a NICU nurse and was about fifteen years older than him. She spent a significant amount of time making sure he knew she was at least twenty years beyond him in practical experience, common sense, and all around skill.

Two very long days into a two-week precepting process and she was already discounting and ignoring almost everything Jamie had to offer. And that’s when he got smart. Instead of trying to verbally convince her he had something of value to offer, he decided to let her “solo” on a tricky, but non-life-threatening task.

She floundered. He made some suggestions and, finally, she listened. This direct experience was the catalyst to her asking questions and paying more attention rather than trying to prove she already knew it all. Jamie had no more need to convince or compel. His trainee understood there were things she’d need to know and learn to do well in her new position. In a very short period of time, she ended up changing her own mind.

Now, what made this work? When Jamie switched from telling to getting this new nurse to participate in a task that required knowledge she didn’t currently have, he created a direct experience for the new hire. People usually dismiss attempts at verbal persuasion but can’t so readily dismiss things they’ve experienced firsthand. These direct experiences are both more memorable and more meaningful.

So, what does this mean for you? Try precepting up front. Shift from a theoretical description of their role to a practical one. Instead of waiting for some type of direct experience to present itself, design a process so that one of the very first, if not the first, activities you engage in are direct experiences. I’m talking about simulations or actual tasks that represent the typical types of situations a nurse will encounter in your unit. It will allow you to see what skills they are bringing to your area so you will have a better sense of how to customize their overall precepting experience. It will also provide a great direct experience for the new hire to get a sense of how different your area is and where they’ll need to focus.

I think you’ll find that as you try to incorporate this idea, you’ll come to appreciate the Chinese Proverb which counsels: Tell me and I forget, teach me and I may remember, involve me and I learn.

Best of Luck,
Steve

Dear David,

My husband struggles with how to engage in conversation with his mother. Mom doesn’t get out much and spends a lot of time with what we consider negative news. When we are together, she shares her opinions as facts. Often sweeping generalizations, “Kids today don’t learn anything in school,” or, “No one . . . ” or, “All those people . . . “. He has tried to gently engage, “Interesting that you think that. What I’ve seen for my kids is they are working very hard and learning a lot in school.” She’ll say something like, “Well of course I don’t mean YOUR kids. But all the other ones who don’t have parents who care . . . ” If he disagrees with her, she acts personally attacked, and as if he doesn’t love her.

My husband has tried being silent and not engaging, but fears he is seen as agreeing and therefore contributing to stereotyping and prejudice in our society. He has tried to bring it up, “When you state your opinions so strongly, I don’t know how to share a different opinion without you feeling hurt that I disagree,” but without luck. Please help!

Signed,
Sidelined by Mom

Dear Sidelined,

What a sad question! Hurt feelings in families are especially painful. And yet, when you hear a loved one make an offensive comment, you don’t want your silence to endorse it. In Crucial Conversations we teach how to disagree in the moment without hurting feelings, but I want to draw on our book, Influencer, to take a longer-term view.

I think the fundamental problem to solve is that mom doesn’t get out much, but wants to contribute to your conversations. I don’t know her so I’m going to imagine she is a bit like my mother or my wife’s mother when they were in their 70’s and 80’s.

Your Data Stream Determines Your Mental Agenda. As my mom entered her 70’s and 80’s, she retired from being a math professor, health problems kept her mostly indoors, she stopped driving, and she moved away from friends to be close to family. This meant that her world shrank into a fairly small bubble. Is this the same for your mom?

Imagine her small world. Where does she get her information? She probably watches a fair amount of television, mostly cable news with a sprinkling of a few favorite shows. Her friends are probably a lot like her, similar in age and TV viewing habits. As a result, her data stream is limited and repetitive. And it’s likely to be skewed towards the negative, because that’s what’s considered newsworthy.

Mom is Still Mom. A mom’s role in the family is a sacred one, and your mom should never give it up. A part of that role is to give advice, share opinions, and protect you from the world out there. I believe that is what she is doing when she makes her “sweeping generalizations.”

Conversations Stall Out. Does the following happen? You and your husband are with mom making conversation. You hit on a topic where she thinks she can contribute, because she heard about it on TV. But, when she speaks up, her comment strikes you as a negative opinion, not a fact. You either go silent or speak up to disagree. The conversation dies and mom feels hurt.

If this is what’s happening, then the question shouldn’t be, “What can I say in the moment?” but, “What can I do to broaden mom’s data stream and deepen our relationship?” Here are a few strategies that worked for my wife and me.

Include Her in Your Data Stream. My wife and I got some excellent advice from a friend. She told us, “When your mom gets into her 70’s, you need to call her every day.” We took that advice and it made a world of difference. It gave us personal topics to talk about, topics that were more important to us than whatever the latest news might be. Weekly calls don’t give mom enough context to contribute, but daily calls make her a part of your life.

We also began taking more photos. We’d send our mom two or three photos a day, just to let her know what we were up to. Then, when we talked at the end of the day, mom could comment on the photos and feel as if she were with us.

Think of ways to connect on a daily basis and to give her more details about your goings on. This will give you more positive and personal topics to discuss.

Create Common Experiences. My mom was a reader, so we started a book club with her—just me, my wife, and my mom. We quickly learned what she liked: John McPhee was an early favorite. As she grew older, we moved to shorter essays and stories. Tove Jansson’s, The Summer Book, and Bern Heinrich’s, One Wild Bird at a Time, became our new favorites. Once again, our goal was to create common experiences and shared experiences that gave us more to discuss than the weather, current events, and politics.

My wife’s mom loved music, so we started watching TV music shows together. This was a bit awkward since we lived three states apart. But the three of us became fans of American Idol, The Voice, and Dancing With The Stars. My wife would call her mom just before the show began to awaken her and make sure her TV was tuned to the right channel. Then, we’d call during commercial breaks to get her opinions on the performances, judges, and competitors. Again, our goal was to have shared experiences that were more relevant and personal than the weather, current events, or politics.

A last piece of advice is to ask mom about herself. Moms have so much history and wisdom to share. Below are a few questions I’ve pulled off the Internet. My wife and I tried some of these with our moms. They can stimulate some rich conversations, but not all of them work with every mom and you may need some patience to get the conversation going.

• How did you meet Dad and how did you know he was “The One”?
• What’s one thing you wish you did differently before you got married or had kids?
• What question do you wish you could ask your mom?
• What’s the hardest thing about being a mom? What’s the best thing?
• What was your dream job when you were younger?
• How many jobs have you had in your life? What did you learn from them?
• Who was your favorite person to spend time with when you were a teenager? Why?
• What kind of car did you learn to drive in? Who taught you?

I hope these ideas help you find more common ground with your aging mother and create common shared experiences that can generate positive conversation. I believe you are seeking for that kind of rich relationship that will benefit you both and I hope you can find it.

Best of Luck,
David

Dear David,

I think many are familiar with the Marshmallow experiment to demonstrate the benefits of delayed rewards. Is there any corollary data that demonstrates that those challenged with delaying rewards (i.e. those who ate the marshmallow) also struggled with avoiding penalties? In other words, do those so inclined ALSO engage in little behaviors to avoid consequences? I think of my daughter who is a marshmallow eater (unlike her brother who would wait). She also would lie a little to cover up a small infraction. But the lie eventually grows to become something with much bigger consequences. The son who understands the value of waiting for rewards is also much more likely to confess a little mistake and “take his stripes” but avoids the major repercussions of a compounding issue. Does data back this up and how can we help those who would eat the marshmallow understand the value of waiting and the penalties of compounding mistakes?

Thanks,
Marshmallow Parent

Dear Marshmallow Parent,

Wow, you’ve put some great thought into this question. Yes, I think the marshmallow study may tie in to what you are observing. But that’s not where I want to start. I’d like to start with how you handle the little lies your daughter is telling.

When Children Lie: Lying is tough because it undermines trust and shows disrespect. It’s hard not to take it personally and get angry. Part of what I like about your question is that you approach the lie with concern and curiosity, rather than moral outrage. I think that’s the best approach you can take as a parent.

For children, lying is often a faulty form of problem-solving. Your daughter has gotten herself into a fix and a lie seems like the solution—albeit a very poor-quality solution. So, treat the lie as a lack of skill and help her work on her ability to problem solve.

Of course, you also have to hold her accountable. Think of a reasonable consequence related to the lie and the problem she was trying to cover up.

For example: Suppose your daughter said she was doing her term paper at a girlfriend’s house when actually she was visiting a young man.

Begin with: “I called Sarah’s house and learned you were at Tanner’s. When you lie to me about where you are and what you’re doing, it makes it harder to trust you. So, you’re grounded for the rest of this week and you can’t see Tanner this weekend.”

Then, explore why she felt she had to lie: “Help me understand why you felt you had to lie about this?” You aren’t looking for an excuse for the lie. Instead, you are trying to understand the reason for the lie.

Finally suggest a better solution: “I would prefer you say, ‘Mom, I know you want me to work on my term paper this evening, but I really want to see Tanner.’ I would listen, and we could talk about it. Of course, there is a good chance I’d say ‘No,’ and you’d be disappointed. But that’s not as bad as lying, and hurting the trust we have.”

Teach Self-Control: In Walter Mischel’s classic studies, he followed four-year-olds who were able to resist eating a marshmallow for fifteen minutes in order to get a second marshmallow. Years later, these strong-willed children scored hundreds of points higher on their college entrance exams, had stronger marriages, earned more in salary, and got promoted more often. He showed that the ability to delay immediate gratification in service of longer-term goals is an important skill.

What people often forget is that Walter, together with Albert Bandura, also showed that self-control is a skill that children must learn, not a capacity they inherit. I remember watching my next-door neighbor teach this skill to his four-year-old. We were at a pool that had a waterslide. The rule for the slide was to wait at the base of the ladder until the child in front of you had landed in the water and reached the side of the pool. Little Ryan had trouble remembering this rule. His father and I were in the water having a conversation, but every few seconds, he’d have to remind Ryan, “Wait, wait, watch the girl in front of you. Okay, now you can go!” Ryan must have gone down the slide fifty times, and, by the end, knew how to hold himself back without reminders.

Of course, Joe, my neighbor doesn’t just teach self-control at the pool. It is a part of his positive parenting every day. He seeks out these teaching moments when he can help his children develop character skills.

Teach Influence: As I suggested earlier, lying is often a child’s last-ditch effort to get their way, when they feel they have no ability to influence their parent. Helping a child mature is all about gradually, sensibly, and safely giving over control. Children who believe they can get their parents to change their minds are more likely to try dialogue and less likely to lie.

But this loosening of reins is easier to advocate than it is to practice. One of my sisters-in-law uses a parenting skill I admire. Suppose her fourth-grade daughter comes in and asks, “Can I go to Mary’s birthday party on Saturday?” Her mom won’t give her an answer right away. Instead, she’ll say, “Convince me,” and then help her daughter make the case. She’s teaching her children how to influence her and allowing them to succeed when it makes sense. As her children have grown into their teenage years and beyond, they’ve maintained this kind of open and honest dialogue with their mother—in part, I think, because they are confident they can influence her.

Do as I Say, not as I Do: Whenever I answer a question about parenting, I feel I need to add that I’m not a parent. My wife and I have 24 nieces and nephews, so we’ve gotten to witness some wonderful parenting, but I don’t practice what I preach. For example, over the years, we’ve had nephews and nieces join us for dozens of “Camp Davids”—hiking Bryce Canyon or the Olympic National Park, unicycling in Moab, and surf lessons in Southern Cal. But these fun adventures don’t really involve much parenting. In fact, Camp David only has one rule: “You can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose.” So, my advice comes from skilled friends and relatives, not from hard-won experience.

Thanks again for your probing question. I look forward to hearing other perspectives on how to handle your situation.

Best,
David

Dear Emily,

I appreciated your blog article Recovering from False Perceptions. I agree that apologies can do more harm than good, and it is important to assess the need and/or reason for the apology. However, that post was more from the point of view of the individual with the false perception. I was interested to see what your advice would be to someone who feels they are the victim of false perceptions. I have an employee whose coworkers have labeled as lazy, uncaring, and untrustworthy. He wants to restore his image/brand with his coworkers and managers. What advice do you have for someone in this situation?

Signed,
Wanting to Help

Dear Wanting to Help,

Combating false perceptions can be frustrating. We often feel as if we are the Victim: “Others have misjudged me despite my hard work, exemplary efforts, and noteworthy achievements!” We may cast our coworkers in a Villain role: “Why can’t they just see me for who I really am?” And then we start to feel Helpless: “This is so unfair and there is nothing I can do about it!”

So, while your question is about personal brand, I’d like to look at it through the lens of what we teach in Crucial Conversations Training about Mastering Our Stories. I will direct my comments directly to your employee, the person who wants to restore his brand.

Victim story: What am I pretending not to notice about my role?

Whenever we tell ourselves a Victim Story (“Woe is me! I am the best, hardest-working employee here and others have unjustly judged me as lazy, uncaring, and untrustworthy.”), we need to challenge our story by asking: “What I am pretending not to notice about my role in the problem?” I have several ideas on how this relates to perception and personal brand:

1. False perceptions don’t exist. There is only your perception of my behavior and my perception of my behavior. Just because your perception is different than mine doesn’t mean it is false. When I judge your perception as false, it lets me off the hook. It allows me to say, “I am right and good and just and you are wrong.” I get to stop looking at me and my behavior because my perception is true and yours is false. But, if I can accept your perception as valid and real, I can shift my thinking and open myself up to self-reflection. I can clearly see what things I have done or not done that may have contributed to your perception.

2. Accept the starting point. You don’t get to tell people what your personal brand is, anymore than Nordstrom or Coca-Cola get to tell people what their brand is. You get to act and people get to perceive. Their perception is your brand. We sometimes confuse personal brand with personal identity, personal values, or personal mission. It is easy to say, “That is not my brand. I am disciplined, focused, and driven.” While it may be true that your personal identity is disciplined, focused, and driven, and that your personal identity impacts your brand, recognize that it is not your brand. Your brand is how others perceive you, not how you perceive yourself. While you get to influence your brand, you don’t control it because you can only influence, never control, others’ perceptions.

Villain Story: Why would a reasonable, rational, decent person do this?

When we tell ourselves the story that someone else has falsely judged us, we get to cast them in the Villain role: “They are wrong. How could they be so unseeing of the true me?” The antidote to a Villain Story is to ask yourself: “Why would a reasonable, rational, decent person do (or think) this?”

3. Understand your brand. If you want to know why someone thinks of you as lazy and untrustworthy, the easiest way to find out is to ask them. But before you rush out to start this conversation, realize this—asking for feedback on your personal brand is NOT a crucial conversation. Sure, the stakes are high and your emotions may run strong. And yes, there are differing opinions. So why is this not a crucial conversation? When we talk about crucial conversations, the goal is to fill the Pool of Shared Meaning: yours and mine. In this particular case however, the goal is to fill the pool with only their meaning. This is a focus group, not a conversation.

Think of it this way. If I work in marketing and want to know what my company’s brand is in the marketplace, I get a group of people together and ask them questions about how they perceive my company. When they respond, I may probe deeper to understand. What I don’t do is say, “Oh, that is interesting and not at all what we are really about. Our company is actually very different than that and here’s why.”

Asking people about your brand is all about getting information and understanding your brand. It is not about you convincing others with your words that they should see you differently.

Helpless Story: What can I do right now to move toward what I really want?

When we accept that we can’t control others’ perceptions of us, it is tempting to tell ourselves a helpless story: “Their perception is their perception and there is nothing I can do.” We fail to see the difference between control and influence. While you can’t control others’ perceptions, you can influence them, as all good brand marketers know. You open yourself to influence when you consider this question: “What can I do right now to move toward what I really want?”

4. Build a positive brand, not a non-negative brand. Don’t wage war against your negative brand and try to convince people that you are “not lazy, not uncaring, and not untrustworthy.” Being “not lazy” is not a powerful brand. Rather than try to erase the negative brand, focus your attentions on defining what positive brand you want to create: “I am a hard worker that gets great results. I am a people person who cares deeply about individuals.”

Once you have defined that positive brand, consider what behaviors or actions on your part would drive that perception in others. What would someone see that would lead him or her to conclude that you are a hard worker who gets results? What would someone see that would lead him or her to the conclusion that you are a people person who cares deeply about individuals?

These might be new behaviors for you. But the key is that they need to be behaviors that are visible to others if they are going to impact others’ perceptions.

Armed with these new behaviors, you can then create a change plan for enacting these behaviors.

5. Close the loop. This is a powerful step in personal brand building. You have asked for feedback on your brand, accepted it, and now acted upon it. Now is the time to go back and close the loop. Return to those who gave you feedback and say: “Here is what I have done with the information you gave me. Have you seen an impact?”

This is powerful for two reasons. First, it validates and strengthens the relationship because you are demonstrating deep respect to the other person. You took what they said and did something about it.

Second, if the other person hasn’t noticed a change (and hence your brand hasn’t changed), this provides a nudge for them to reflect and re-evaluate. They might say, “I hadn’t noticed the change, but now that you point it out . . . ” Or, if upon reflection, they haven’t seen the change and their perception hasn’t begun to shift, that is a great data point for you as you consider whether the behaviors you have changed are driving the results you want.

I hope this gives you some helpful ideas. Just remember, your personal brand is about you, not about the other person. You can influence your brand when you stop telling yourself Victim, Villain, and Helpless Stories.

Good luck,
Emily

Dear David,

I work as a director for a center that serves children with special needs. We are part of the Department of Pediatrics of a public university/hospital system. I have been the director for two years now and have an issue I am not sure how to solve. We work for a public institution, so the salaries for the caregivers who work in the classrooms are barely above minimum wage and not competitive locally. Because of this, our center is a revolving door for caregivers who are a critical part of our team. I am unable to raise the salary, so how do I keep employees, find new employees on a regular basis, and keep up the morale of the center and myself? I feel so discouraged most of the time because it’s an issue I can’t control, nor will it change in all likelihood. I am seriously considering leaving.

Best Regards,
Turnover Troubles

Dear Turnover Troubles,

Many leaders find themselves in your position. They struggle with turnover within their essential, but low-paying positions. I’ve worked with many of these leaders, so—while my advice won’t be especially welcome, it is truly battle-tested.

I think you need to re-set your expectations of what’s possible. You may not be able to ever “solve” your retention problem. The turnover numbers within your group may always be higher than ideal. However, there is a worse problem than actual turnover: It’s what we call “spiritual turnover.” Spiritual turnover happens when people stop being engaged, involved, motivated, or psychologically present at work. Their bodies may keep walking the halls, but their souls have left the building.

These organizational zombies are far more costly than actual physical turnover. They prevent your team from achieving its mission, and create safety and customer-experience problems as well. I think your goal should be to keep your employees as engaged and positive as possible—even when you know that many of them will only be with you until they find a better-paying job.

Gather Information: Begin by gathering information from two groups: a.) Long-term employees who you value and respect, and b.) Past employees who have been gone for at least three months.

Ask the long-term employees about their motivations for staying. Find out what is working for them. Is it pride in their work? Friendships with other team members? The impact they have on the people they serve? Work to build on these strengths.

Ask the past employees about why they left, what they liked/disliked about the job, and what they are doing now. One of your goals will be to reduce unappealing elements of the job. But, just as important, look for patterns in their career steps. For example, are your employees “graduating” to a better-paying job within healthcare? Within your same hospital? Are they going back to school? Are they really getting better-paying jobs, or are they stuck?

Connect to Values: Employee engagement requires a strong connection to at least one of the following four values:

• Development: Some find meaning in the growth the job offers—in the way it prepares them for the next step in their career.
• Job: Some find meaning in the tasks or the craft of the job. They identify with the profession.
• Customers: Some find meaning in helping the people they serve—in your case the children and their families.
• Team: Some find meaning in being a valued member of a winning team—in close friendships and being counted on by others.

I’ll suggest a few actions you can take in each of these areas.

Development: I hope your past employees have moved on to better jobs—and that they see their time with you as having helped their careers. One approach you might take is to turn your team into a world-class farm team for your hospital (or for professional schools). Make sure your employees get the training, experience, and coaching that will help them be most valuable to other departments. Create opportunities for employees to showcase their skills and to learn more about opportunities they can strive for. Your employees will value their time with you, because they see what you are doing for their careers. Employees will want to join your team, because they know it’s a great way to enter into a career in healthcare.

Job: My experience is that teachers take a lot of pride in their profession—and are also quick to point out obstacles that prevent them from practicing their profession. Often the best way to tap in to this source of motivation is by removing distractions and disruptions so that your employees can focus on what they do best. In addition, set high professional standards, and involve the whole team in holding each other accountable for achieving them. It’s hard to take pride in your work, if the standard isn’t high.

Customers: My guess is that most, if not all, of your employees take pride in the impact they have on the children and families they serve. Build on this pride by making these connections more visible, more personal, and more frequent. Find ways to track the impact your employees are having, and share and celebrate this impact. Create face time between your employees and children’s families.

Team: Make sure your employees feel like a valuable part of your team. Find ways to have them work with partners or in small groups. Create opportunities for them to get to know each other—and discover similar interests beyond work. Make sure each person knows that others on the team are counting on them, and value their contributions.

I hope these suggestions will help. Again, I think employee engagement is a better measure than turnover for leaders in your position.

Best of Luck,
David

Dear Joseph,

I have an employee who is not aware of conversation protocols we all take for granted. He talks on and on without noticing the other person wants to leave the conversation. He questions people excessively, demanding exact details and when they don’t provide what he wants, he tells them how disappointed he is. He misses cues—taking things literally that were meant figuratively—and generally just doesn’t seem to “get it.” When I recommend he work on communication skills and supply resources for doing so, he denies he has a communication issue. The issue is affecting the morale of other team members, and people are starting to avoid him. How do we help him see the need for change?

Sincerely,
Communication Gaps

Dear Communication Gaps,

You raise a very interesting question—one that has got my “spidey sense” tingling. You’ve laid out a set of clues that I suspect is making many of our readers jump to the same conclusion I am. But before I go there, let me suggest a principle.

When you want to address someone’s behavior, your first task is to diagnose. You must try to determine whether their current behavior represents a motivation problem, an ability problem, or a mix of the two. When your employee talks long past others’ interest, is he doing that because he doesn’t care about others’ needs, or because he simply doesn’t see the cues? When he tells you he has no communication issues, is it because he is knowingly arrogant, or sincerely unaware? Or some of both? How you answer this question can point you in completely different directions for a response.

And that’s where my “spidey sense” comes in. You describe a pattern of behaviors—including missing social cues, obsession with detail, inability to differentiate substantive from irrelevant information, missed conversational subtlety (sarcasm, figurative references)—that sound like classic symptoms of Asperger syndrome or something on the Autism spectrum. Here’s a description you can use to see if other evidences of Asperger’s fit what you’re experiencing.

If you conclude someone has the ability to behave appropriately but chooses not to, you’ve got a motivation problem. You can respond by helping them understand how their behavior affects others. You can impose consequences. You can help them see how it will undermine values they already hold. There’s a lot you can do to influence motivation.

If, on the other hand, the person lacks ability, you can offer training or coaching. But now we must nuance even the diagnosis of ability problems. There is a difference between ignorance and disability. In the first case, your employee has the basic cognitive and motor capacity to behave differently, but has no training in doing so. If this were the situation, your challenge would be to find a way to convince him of his behavioral problem and then engage him in an acceptable process of development.

If, however, he is in the second case, the situation is much more difficult. With Asperger syndrome, and even with other Autism spectrum disorders, development is possible. However, it comes with much more profound practice and feedback than your typical skill building class. If your employee has a challenge of this kind, and has not been diagnosed, you are in a tricky situation for attempting to influence change. You will have a much more difficult time helping him see his own behavioral gaps. And, any intervention you suggest to help him address the gaps would have to measure up to the special hurdles he’ll face in developing greater interpersonal sensitivity.

If this were my dear friend, I would do three things:

1. Validate whether Asperger’s might be involved by looking more broadly at his behaviors and Asperger syndrome indicators.
2. Lovingly broach the subject of his behaviors and their coincidence with this condition.
3. Suggest further diagnosis.

Given that he is an employee, you have extra HR considerations I urge you to review. And within those boundaries, I would find a way to be as helpful to him as I could.

I wish you the best,
Joseph