Andrea Lombardi, BA, MBA, BHScPA, CCPA October 25, 2014

1. Introduce concepts of facilitative leadership 2. Draw parallels between communications skills taught in PA curriculum and facilitative leadership approach 3. Open floor to interactive discussion

 The Skilled Facilitator (2002), Roger Schwarz  The Skilled Facilitator Field Book (2005), Roger Schwarz et al 

 Approach to leadership and group decision making  How one thinks is how one leads  Helps leaders shift beliefs, thus changes way they lead

 I understand some things. So do you. Let’s learn and move forward together.  I understand, you don’t. I’m right, you’re wrong. I will win.

Source: Adapted from Argyris & Schön, 1974, and Action Design,  I understand the situation; those who disagree don’t  I am right; those who disagree are wrong  I have pure motives; those who disagree have questionable motives  My feelings and behavior are justified  I am not contributing to the problem 1.State my views without asking for others’ views and vice versa 2.Withhold relevant information 3.Speak in general terms and don’t agree on what important words mean 4.Keep my reasoning private; don’t ask others about their reasoning 5.Act on untested assumptions and inferences as if they were true 6.Control the conversation 7.Focus on positions, not interests 8.Avoid, ease-in to, or save face on difficult issues 9.Use an arbitrary decision rule or don’t discuss it  Lower quality decisions  Ineffective solutions  Unnecessary costs  Decreased commitment  Poor follow through on decisions  Solutions that don’t stick  Longer implementation times  Strained working relationships  Reduced trust  Defensiveness  Unproductive conflict  Inappropriate dependence on others  Less personal satisfaction  Missed opportunities for growth and development  Unnecessary stress  Decreased learning  Misunderstanding  Denial and blaming others for mistakes  Rigidity MindsetBehaviorResults  Win, don't lose  Be Right  Minimize expression of negative feelings  Act rational AssumptionsValues

Source: Adapted from Argyris & Schön, 1974, and Action Design,  I have some information; so do other people  Each of us may see things the others don’t  I may be contributing to the problem  Differences are opportunities for learning  People may disagree with me and have pure motives 1.State views and ask genuine questions 2.Share all relevant information 3.Use specific examples and agree on what important words mean 4.Explain reasoning and intent 5.Test assumptions and inferences 6.Jointly design next steps 7.Focus on interests, not positions 8.Discuss undiscussable issues 9.Use a decision-making rule that generates the level of commitment needed.  Higher quality decisions  Innovative solutions  Cost savings  Increased commitment  Follow through on decisions  Solutions that stick  Shorter implementation times  Improved working relationships  More trust  Less defensiveness  Productive conflict  Appropriate dependence on others  Greater personal satisfaction  Increased growth and development  Less stress  Increased learning  Greater understanding  Embracing and learning from mistakes  Greater adaptability MindsetBehaviorResults  Transparency  Curiosity  Accountability  Informed Choice  Compassion AssumptionsValues

 Mutual Learning: ◦ Midset  Values  Assumptions ◦ “Ground rules” - behaviours ◦ Results

 Transparency – sharing relevant info, including thoughts, feelings, intentions  Curiosity – being genuinely interested in others’ views; recognizing other people have info that you do not  Accountability - accepting responsibility for actions and consequences

 Informed choice – making decisions and maximizing others’ abilities to make decisions based on relevant info in way that builds commitment  Compassion - willing to temporarily suspend judgment to appreciate your own and others’ situations

 I have info and so do other people  People may disagree with me and still have pure motives  I may be contributing to problem  Each of us sees things others do not  Differences are opportunities for learning

1. State views and ask genuine questions 2. Share all relevant info 3. Use specific examples and agree on what important words mean 4. Explain reasoning and intent 5. Test assumptions and inferences 6. Jointly design next steps 7. Focus on interests, not positions 8. Discuss “undiscussable” issues 9. Use decision making rule that generates commitment level needed

 Provide more guidance than procedural or abstract ground rules  Shorter implementation times  Increased commitment  Higher quality decisions  Increased learning  Improved working relationships  Greater personal satisfaction and well-being

 You are a PA working in an inpatient ward of a hospital  On a recent initiative conducted by Infection, Prevention and Control, your team scored lowest on proper hand hygiene audit  Your team consists of a physician, nurse, pharmacist, physiotherapist, social worker, and students (and yourself, the PA)  You are meeting with your team

© The New Yorker Collection Robert Mankoff from cartoonbank.com. All Rights Reserved.

 State your point of view and explain your reasoning  Avoid rhetorical or leading questions ◦ “Do you really think will work?”  Ask genuine questions that stem from curiosity ◦ “I’m not seeing how this will work because of x. What are you seeing that leads you to think it will work?”

 Help create common pool of info that everyone can use  Relevant information – anything that might affect decision  People underestimate dangers of not sharing relevant information  Feelings ARE relevant

 We use A LOT of jargon and abbreviations  PAs are team-based, inter- professional clinicians, we don’t just communicate with physicians and nurses!  Shared understanding is key to decision buy-in

 We are hard-wired to make meaning out of events  Providing explanation helps reduce others making assumptions  Sharing your reasoning  more transparent  trust  Be curious, and ask others to do same

© The New Yorker Collection Cheney from cartoonbank.com. All Rights Reserved.

 Assumption – taking something for granted, without any info  Inference – drawing conclusion about things you don’t know, based on things you don’t know  Step 1 – awareness  Step 2 - identify what other person said/did that led to your inference

 Advocate your point of view, inquire how others see it, jointly craft next step  This invites people to share their thoughts and challenge status quo  Inviting team members to actively participate in designing solution translates into stronger buy-in

 Interests – criteria that need to be met in order to solve problem in way people support  Interests motivate people, can be quite fixed  Positions - what people think will serve their motivations, can be very flexible  Focusing on interests creates more options for potential solutions that meet those interests

 Issues not discussed openly by team  Relevant to team’s work  Often discussed everywhere else except team  Reduces team’s effectiveness  Most difficult ground rule  Approach with compassion

Group decision-making process types: 1. Unilateral 2. Delegative 3. Consultative 4. Democratic 5. Consensus  When you need greater commitment to ensure decision is implemented effectively, it makes sense to have greater involvement in process

1. Initiate session ◦ Establish initial rapport ◦ Jointly design reasons for consultation 2. Gather information ◦ Encourage patient to tell their story ◦ Ask open ended questions ◦ Listen attentively ◦ Clarify ambiguous terms ◦ Encourage patient to express feelings

3. Provide structure ◦ Structure interview in logical sequence 4. Build relationship ◦ Use appropriate body language ◦ Develop rapport, use empathy ◦ Be non-judgmental ◦ Acknowledge views and feelings ◦ Share thinking

5. Explain and plan ◦ Provide information ◦ Elicits patient beliefs, reactions ◦ Shared decision making about next steps ◦ Ensure all concerns addressed 6. Close session ◦ Summarize session ◦ Final check

 Builds relationship: shows interest in patient, uses body language appropriately  Opens discussion: asks questions to elicit full set of concerns, negotiates an agenda for visit

 Gathers information: asks open-ended questions, clarifies details, asks what is meant by ambiguous language to better understand the patient’s story  Shares information  Reaches agreement  Provides closure

 Conversation about change (counseling, therapy, consultation, method of communication)  Collaborative approach (person- centered, partnership, honors autonomy)  Evocative approach (seeks to call forth person’s own motivation and commitment)

 Approach: ◦ Open-ended questions ◦ Affirmations ◦ Reflections ◦ Summaries

 PAs are trained in models for communicating with patients, which are directly aligned with facilitative leadership approach to leadership and team-based decision making  Thus, PAs are well positioned to be facilitative leaders within organizations to help build stronger, healthier working culture

 This will translate into improved: rapport with physicians and allied health professionals, problem solving, outcomes, quality of work life, patient care, etc.  Will also help strengthen reputation of PAs as leaders, and thus profession in Canada

 Calgary-Cambridge Guide to the Medical Interview  Kalamazoo Observation Guide  Leadership Retreat, Oncology Program, Sunnybrook Health Sciences Centre (Oct. 15, 2007, Oct. 24, 2008., Nov. 16 & 17, 2009)  The Skilled Facilitator (2002), Roger Schwarz  The Skilled Facilitator Field Book (2005), Roger Schwarz et al  mi.html 