1. Confrontation Some Practical Guidelines for Confronting Others Effectively The Portable Mentor Presentation Series A Presentation for SOMC Physician Leaders’ Forum Kendall L. Stewart, MD, MBA, FAPA April 25, 2002 SOMCPress

2. What’s in this for me? Most people find it easier to talk about others than to talk to them. People don’t read our minds nearly as well as we wish they would; Subtle hints rarely work. Failure to confront others leads to resentment, misunderstanding and frustration. Angry confrontation rarely helps. Effective confrontation is an art. You can learn to confront others more effectively. The quality of your life will improve as a result. A manipulative preacher asked all the righteous people to turn around and face sinners.

3. What strategies will promote more effective confrontation? Clarify the issues Specify the problem Explore your options Decide whether confrontation is the best option Prepare to confront Deal with your own feelings Ask permission to confront Confront in love State your position Seek to understand Know when to abort the mission Invite suggestions Be prepared to suggest some solutions Specify next steps Document the confrontation Follow through as promised Accept the consequences Practice, model and mentor others An arrogant surgeon reminded me that other perspectives always exist.

4. Deal with your feelings. Why? –A variety of unpleasant feelings are normal during the preparation stage. –Dread, apprehension and frustration are usually part of the mix. –Few of us long to hurt others. –All of us want others to like us. –Unrecognized feelings are the most dangerous. –Uncontrolled feelings always distort communication. How? –Identify, accept and express your feelings. –Writing and then destroying a letter detailing how you feel can be very helpful. –Allow intensity of feelings to fade over time. –Stop pointless rumination and obsessive stimulation. –Employ healthy distractions. –Consider meditation. I once asked an angry physician if she would like to hear my perspective.

5. Prepare to confront. Why? –It is easy to get distracted –Impulsive speculations about the other person’s motives will derail the entire process. –Lack of preparation encourages defensiveness and directs attention to current feelings and away from critical perceptions. How? –Write out your position beforehand. –Document what was observed. –Prepare to explain how the observed behavior made others feel. –Come up with some acceptable options. –Identify some suggested next steps. Before marriage, prepare a list of what you like and don’t like about each other.

6. Ask permission to confront. Why? –It is a courtesy you would appreciate if the tables were turned. –It gives the other person time to prepare to listen, to hear and to acknowledge your view. –This approach encourages an exchange of perceptions instead of accusations. –Respectful discourse increases the odds to making some lasting change. How? –Wait until your emotions cool so that your request will not come across as a demand. –Be brief and direct. –Identify the issue and express your concern. –Set a definite time for a more complete discussion. –Resist being drawn into a premature discussion before both of you are ready. I once confronted administrators who had discriminated against my patients.

7. Confront in love. Why? –The underlying message is usually lost in the blinding flash of an angry attack. –An angry confrontation leaves permanent emotional scars and stands little chance of producing lasting change or sustained relationship. –People are more likely to pay attention to those they believe admire and respect them. How? –Everyone possesses strengths and weaknesses. –Reflecting on these strengths will put you in the proper frame of mind. –Open the confrontation with sincere acknowledgement of this person’s strengths. –Focus on behavior. –Assume the best of intentions and a lack of malice on the offender’s part. An admired college professor confronted me about an unethical speech.

8. Try to understand. Why? –Misunderstandings are at the heart of many conflicts. –People always have what they believe are good reasons for behaving as they do. –Those who feel understood are more willing to take responsibility for their actions. How? –Listen non- judgmentally to their point of view. –Listen to what they mean, not what they say. –Accept their feelings. (This does not mean their actions are acceptable.) –Focus on patterns of behavior, not individual incidents. An angry woman confronted me about my consultation on her father’s case.

9. Follow through as promised. Why? –Confrontation is only the first step in the change process. –The pain of the confrontation behind us, we don’t want to rock the boat again. –Without being held accountable, all of us will slip back into our old ways of doing things. –Improved behavior that is reinforced is more likely to continue. How? –End every confrontation with plans for specific next steps. –Nobody’s perfect. Cut people some slack–but not too much. –Avoid the ambush. Make an appointment to evaluate progress. –Invite comment about whether you are keeping your end of the bargain. –A written note for the opportunity to be open is generally well-received. You may have to state the obvious. A man came in complaining of silent gas emissions.

10. What are some of the take home points? Confrontation is hard. Effective confrontation is even harder. This vital interpersonal skill can be learned and improved with practice. The ability to confront others effectively will improve the quality of your life.

11. Where can I learn more? Stewart, Kendall L, “Confrontation: Some Guidelines for Effectiveness.” A SOMC White Paper, SOMC Press, 1999. This White Paper can be downloaded from http://www.somc.org.http://www.somc.org Stewart, Kendall L, The Portable Mentor: Guidelines for Organizational Effectiveness. (In Press) Stewart, Kendall L, “Confrontation: Some Practical Guidelines for Confronting Others Effectively,” The Portable Mentor Presentation Series, SOMC Press, 2002. This presentation can be downloaded from http://www.somc.org.http://www.somc.org

12. How can we contact you? Kendall L. Stewart, M.D. Medical Director Southern Ohio Medical Center 1805 27th Street Portsmouth, Ohio 45662 740.356.8153 stewartk@somc.org www.somc.org

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