In a previous role, I once worked to develop and grow a subspecialized, niche program with four separate physician practices, aligned with our hospital through various models. In the beginning, we all knew it was going to be great. We had engaged physician partners developing the vision and strategy, the right operational expertise and infrastructure to support the program, and the buy-in needed from a system level. We conducted initial strategy sessions, had site visits, vendor presentations and engaged all levels of stakeholders to ensure those who would be hands-on with patients had a voice in the program development.
But then, at some point, it started to break down. We stalled. Fewer people showed up to the meetings, the loudest voices were the only ones heard in the room, and groupthink easily took over debates that were once filled with excitement and possibility.
Instead of the passion, progress, and momentum lifting us up and floating us over the finish line, it felt as if we were pushing a large boulder up a very steep hill.
What happened? In short, there were too many elephants in the room.
And most importantly, we lacked acknowledgment of these elephants in a way that was productive and added to our momentum. Instead, the elephants plopped down on those boulders that we were rolling uphill, making it almost impossible to reach the level of excitement we once had.
In hindsight, I knew those elephants existed. And if I am completely honest with myself, I would admit that the risk of addressing those elephants seemed, at the time, too high. What if I called them out and the entire program blew up?
Is it really that bad to just sweep those elephants under the rug?
The answer to that question is yes. There is simply no rug big enough to hide the elephants forever. It’s like playing hide-and-seek with my 4-year old son, it’s impossible not to see the big lump “hiding” under the rug in the middle of the room.
While it might seem daunting to address the elephants, the risk of letting them roam about the room is a lack of true connection, honesty and openness. Without these traits, ultimately, we end up with fear driving the bus and innovation riding in the back seat. The long-lasting results we want never come to fruition.
The following are the two elephants that commonly present themselves when leading diverse groups of people and tend to be the root cause of stalled results.
Elephant #1: The underlying human needs present in each team member that are not acknowledged and addressed
No matter the letters behind our name, we are all human. We all have underlying needs. For example, we all need to feel safe and secure, we all need to feel connected, valued and heard.
When these needs go unmet, we can feel resistance to even the smallest of changes. We might find ourselves going to a place of negativity or getting defensive. We switch from working as a team to “what’s in it for me.”
We must all get our needs met so that we can contribute in a productive way to big picture thinking.
There are some very common needs that at a human level, each one of us might value differently. For example, some of us need, first and foremost, to feel a sense of certainty in our lives. That certainty might take the form of job security or perhaps knowing in advance what our week is going to look like. On the opposite end of the spectrum, others of us might value a sense of uncertainty or prefer a level of risk in our lives.
In the case of the program development example above, those who valued certainty needed a level of detail around how they would get patients funneled to their clinic and how their day to day role might change from their current structure. On the flip side, those that enjoyed more risk and uncertainty didn’t need to know exactly what was going to happen next. They wanted to move fast in program development and took a “we will figure it out” approach.
In the end, there was a push-pull dynamic between these conflicting needs that stalled the program. When someone was trying to speed things up, there was someone else who was trying to slow things down.
So how can we ensure our team members’ needs are met? One simple way to uncover underlying needs is by asking two basic questions.
- What’s most important to you?
- How might we proceed in a way that takes into consideration what’s most important to you?
These two questions, in the program development example above, would have sounded like the following:
“What’s most important to you personally and to your practice as we develop and grow this program?”
“What are your suggestions for how you ensure you get what’s most important to you?”
Once we have that information for each participant, we can then have a conversation that is solution-oriented around ensuring we address what is most important.
We all have a common need to be heard and understood, and by asking these simple questions it provides an opportunity for each team member to have a voice.
Elephant #2: The negative voice in our heads that is unknowingly sabotaging the work
We all have the choice to apply positive or negative meanings to a situation. How we interpret events or scenarios colors are behaviors and results. When we interpret a situation to mean something negative, we behave a certain way. When we interpret a situation to mean something positive or even neutral, we behave in a different way.
For example, let’s say you have a busy day in the clinic and your first patient is 40 minutes late.
A negative meaning you could apply to that situation is: “My patients don’t respect my time and think they can show up whenever they want. Now I’m going to be behind all day!”
The result of applying that negative meaning might be that you find yourself being short with patients and in a bad mood all day because you feel rushed and judged by other patients who are waiting for you.
Now what might happen if you apply a more neutral or positive meaning to that situation?
When your first patient is 40 minutes late, what if the voice in your head said this:
“I have no control over whether my patients are late or not, but what I can control is that I am present with each patient, listening and addressing their concerns in an empathetic way.”
The result is that you immediately get into solution-mode and have your staff help manage the rest of the schedule, setting expectations for subsequent patients. You recognize you can’t control patients’ actions, but you can control how you deliver your care to them.
When we apply a negative meaning, the voice in our heads can spin us out of control in a negative way. We must be conscious of the meaning we give to situations because it impacts our entire team.
The meaning we apply to situations will directly impact its success. In the case of the program development work, one physician who, in the end, backed out of the program, felt that the development of the program meant less autonomy for her and her practice. Another physician took the program to mean he would have more opportunity to collaborate and he was a primary driver of innovative discussions. Two different meanings and two different behaviors.
You can uncover your team member’s meaning (and get a glimpse of the voice in their heads) by simply asking questions like:
- What could this mean for you or you practice if we were successful?
- What might this mean if the program doesn’t succeed?
Next time you lead a team meeting, notice the elephants and try asking the suggested questions. Let me know how it goes, I’d love to hear from you!
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