What is the true cost of a hostile work environment?
Speaker:In a high stakes job, like medicine.
Speaker:It could be the patient's life.
Speaker:If you work in an environment where you don't feel safe to call out a
Speaker:potential mistake, or even ask a question, this can be incredibly
Speaker:stressful and potentially dangerous.
Speaker:And what if you witnessed someone being rude or disrespectful?
Speaker:Is it your responsibility to deal with it, or is there a chance you could make
Speaker:life harder for the people involved?
Speaker:In this episode, I sat down with Dr.
Speaker:Chris Turner, a consultants in emergency medicine and the co-founder
Speaker:of the Civility Saves Lives movement.
Speaker:He discovered how important it is to create a space where it's
Speaker:okay to challenge or ask questions without risking humiliation.
Speaker:if you've ever worked for a difficult boss or you've seen someone
Speaker:mistreated and haven't known what to do, this conversation will give
Speaker:you some practical strategies.
Speaker:As well as things to think about.
Speaker:And if you're a leader under pressure, you'll learn how to foster a more
Speaker:psychologically safe environment where challenge is welcome.
Speaker:If you're in a high stress, high stakes, still blank medicine, and you're feeling
Speaker:stressed or overwhelmed, burning out or getting out are not your only options.
Speaker:I'm Dr.
Speaker:Rachel Morris, and welcome to You Are Not a Frog.
Speaker:My name's Chris Turner.
Speaker:I'm a consultant in emergency medicine at university, also
Speaker:as a Coventry in Warwickshire.
Speaker:And a few years ago I co-founded Civility Saves Lives, which is a
Speaker:grassroots organization dedicated to raising awareness of the impact of
Speaker:behavior on performance at individual team and organizational level.
Speaker:We do it primarily within healthcare, but it's kind of spidered out.
Speaker:We do it in other places as well.
Speaker:Thank you so much for coming on.
Speaker:I've wanted to have you on for a long time, and I know this has taken quite
Speaker:a long time to set up, hasn't it?
Speaker:This interview, because a, a friend of mine who's also an ED consultant's been
Speaker:saying to me for ages, you've got to get Chris Turner on your podcast because his
Speaker:work has been totally transformational.
Speaker:So, um, for those people that don't know what the Civility Saves Lives movement
Speaker:is, what, what is it and how did it start?
Speaker:Okay, so firstly I should probably say it's not my work.
Speaker:The vast majority of this is other people's work, which we brought
Speaker:together and, um, kind of packaged.
Speaker:I mean, I, I introduced some of my own work in it, but, um, Civility Saves
Speaker:Lives is really, it's really all about discussing with people how behavior
Speaker:matters, how their behavior matters, and actually about understanding the impact
Speaker:that other people's behavior has on us.
Speaker:And it came about because there was a guy called Joe Farmer who
Speaker:worked with us and he was an F1.
Speaker:And we very rarely have F1s in the emergency department.
Speaker:And for some reason we had F1s for a few months.
Speaker:A few months after he left, he sent me an email, said, Chris,
Speaker:can I come and talk to you?
Speaker:And I've gotta say, I mean maybe this speaks of my personal paranoia, but
Speaker:I thought, Oh, I wonder some, I did something bad when we worked together and
Speaker:I wonder if you have now got the courage up to come and talk to me about it.
Speaker:Either way, you know, whatever it is, I'm gonna have to speak to you.
Speaker:So I arranged to see him.
Speaker:And we went and we went along to one of the coffee places in the hospital
Speaker:and I said, so how are you doing?
Speaker:And what's up?
Speaker:And he said, well, I have to do, I have to do a project, I
Speaker:have to do a talk on something.
Speaker:Um, and I thought, who does the weirdest stuff that I know of?
Speaker:And thought Chris Turner.
Speaker:He's interested in odd stuff.
Speaker:Yeah.
Speaker:Yeah.
Speaker:So I'd be worrying about this nicely.
Speaker:He just thought I was a weirdo.
Speaker:Um, and so we sat down and started talking about, I'm very used to people
Speaker:regarding the things that I'm interested in as being a little bit left field.
Speaker:And we got to talking about stuff and we, we talked early on about sort
Speaker:of behavior and then we talked about a whole bunch of different things.
Speaker:And then he told me a story.
Speaker:And the story was of him and his registrar, him and his registrar
Speaker:going to theater one night.
Speaker:So it was a surgical specialty registrar.
Speaker:And they had to go to theater 'cause it was an emergency.
Speaker:And Joe knew this reg really well and she was apparently
Speaker:fantastic and really just on it.
Speaker:And they go to theater and they're there with a consultant that
Speaker:he doesn't, Joe doesn't know.
Speaker:And the consultant says to the reg, This is your operation on you go.
Speaker:And she started operating.
Speaker:Then pretty quickly it became clear that the consultant was sort of asking
Speaker:question, question, question, and it they became slightly more intrusive, slightly
Speaker:more nippy, slightly more hostile.
Speaker:And Joe said that what he watched was somebody who he knew to be a wonderful
Speaker:gifted clinician, turned from that version of herself into somebody who could barely
Speaker:speak and barely make a cut without looking like she couldn't do anything.
Speaker:And eventually the consultant took over the operation.
Speaker:And we were just talking about it, but I had just read some work by Christine
Speaker:Porath and a little bit of work by Amir Erez about what happens to us
Speaker:when we're put into that situation.
Speaker:And it was a proper light bulb moment for me because it was that realization that
Speaker:it's not just me that this happens to.
Speaker:I always thought of it as a personal feeling that I couldn't cope with this
Speaker:sort of, um, undermining and abuse that sometimes exists within the workplace.
Speaker:And I thought that I should be stronger.
Speaker:Maybe I'm just too soft to work around here.
Speaker:And that realization that this was actually a human reaction, it wasn't
Speaker:because I wasn't enough, it was because this is how humans react in that situation
Speaker:and the vast, vast majority of us do.
Speaker:And so we thought we'd give a talk.
Speaker:We'll give a talk on this.
Speaker:And we, very early on we decided to give it a name, which is pretty
Speaker:damn grandiose, if you don't mind me saying so, you know, I mean it.
Speaker:Why did we think that our, our one talk needed a brand,
Speaker:but we decided that it did.
Speaker:Maybe just a tagline.
Speaker:Very early on, we went with Civility Saves Lives, and then we discarded it
Speaker:because it didn't feel punchy enough.
Speaker:And then we went with Don't be a.
Speaker:And after Don't be a, you can add any primary or secondary
Speaker:sexual characteristic.
Speaker:You can add any euphemism, you can add anything you like,
Speaker:and that feels more punchy.
Speaker:The problem with that is that nobody goes to work to be a dick.
Speaker:And what we'd have ended up doing is having this talk that was basically
Speaker:the equivalent of pointing a finger at people and saying, don't be
Speaker:a, don't be a, when most of us don't see us in that mode anyway.
Speaker:And I had at that time recently met Adrian Plunkett, who Adrian and Emma
Speaker:started Learning From Excellence.
Speaker:And Adrian and I had been talking about Prosociality and how to
Speaker:get people on board with things and the power of aspiration.
Speaker:And eventually Joe and I circled all the way back around to Civility Saves Lives.
Speaker:And we decided to call it that.
Speaker:And we got a lot of criticism for it in the first place because people said
Speaker:nobody will know what civility means.
Speaker:They don't understand that as a word, but it is actually the academic word.
Speaker:It's the word that people use in the papers.
Speaker:And that felt important that we weren't just telling people to be nice what
Speaker:we were doing, saying that there are certain behaviors which genuinely
Speaker:make a difference to outcomes.
Speaker:And that was how it came about.
Speaker:And you know, we sort of, we went and gave a, we gave a talk each, and then
Speaker:we both got invited back to give other talks and other talks and other talks,
Speaker:and it gained its own little momentum.
Speaker:And then eventually I got asked to do, uh, I got invited to do TEDx
Speaker:NHS, which was, uh, which was great.
Speaker:Well, it's such an interesting story 'cause, 'cause on the face of it,
Speaker:and by the way, side note, I love that branding, Civility Saves Lives.
Speaker:It's, I'm all for, I'm all for a good brand.
Speaker:And what I love about it is like, everybody can be civil.
Speaker:Okay?
Speaker:Even the biggest clunker in the world can be civil.
Speaker:They can manage it, you know?
Speaker:So if you'd saved niceness saves lives, that that doesn't really
Speaker:work, 'cause not everyone can be nice, but everyone can, can be civil.
Speaker:Like if the, if the king came up to you today, you would be able to be
Speaker:civil no matter what state of mind you are in, probably, hopefully.
Speaker:Uh, so everyone can aspire to that.
Speaker:And then the saved lives is that this really, really matters.
Speaker:So I think it's a totally brilliant branding.
Speaker:I, my question is, what was it about Civility Saves Lives that
Speaker:was just so astonishing for people?
Speaker:I think it was that we were, we were saying that something that we do
Speaker:all day every day, which is interact with other people, was fundamental
Speaker:to the quality of care that we were able to give in healthcare.
Speaker:Because for most of us, we go through an exam process to gain credibility, and
Speaker:that exam process is always about us.
Speaker:You know, I, I go, I've done many, many exams and it's always
Speaker:been about me knowing stuff.
Speaker:It's never been about me getting the best outta the people around me.
Speaker:Even in os when I interact with other people, it's about me knowing stuff.
Speaker:The oskies tend to be command and control because they're testing my
Speaker:ability to know things .When actually, once you become part of the team, and
Speaker:if you can't do everything yourself, then the minimum unit of performance
Speaker:is not the individual, it's the team.
Speaker:I, so if I'm running a example, often uses this.
Speaker:If I'm running a trauma team, I could be the best trauma team leader in the world.
Speaker:And I'm not, I mean that's probably Caroline Lecher and Vir Virgo who are to
Speaker:the people that I work with who are just absolutely fantastic trauma team leaders.
Speaker:But I could be it.
Speaker:And if I went in that room and I was the best trauma team leader in the
Speaker:world ever, if nobody else was there to help me do it, that would be a
Speaker:catastrophically bad trauma team.
Speaker:And it's a wee bit like having the best tires in the world and
Speaker:claiming you've got the best car because you need everything else and
Speaker:everything needs to work together.
Speaker:So the minimum unit of performance when you have to work with
Speaker:other people becomes a team.
Speaker:And that's quite a challenging thought.
Speaker:I find it an immensely challenging thought.
Speaker:By the way, it's a Michael West comment and that that's where that comes from.
Speaker:And I think once people started to consider this idea that we are measured
Speaker:on personal mastery and exams, that's us knowing the answer to everything, but we
Speaker:get our results in in team situations.
Speaker:So our results are dependent upon team mastery, once you start talking
Speaker:about that, people go, Oh, maybe I could be even better if I thought
Speaker:a little bit more about this.
Speaker:And for what it's worth, the the most important thing when we are
Speaker:working in teams in complicated and complex situations appears
Speaker:to be information sharing.
Speaker:How much information are we choosing to share with each other?
Speaker:And if you think about it, that makes a ton of sense.
Speaker:Because if I'm the trauma team leader, literally everybody in the
Speaker:room knows stuff that I don't know.
Speaker:They've all got stuff going on in their heads that I don't
Speaker:know, some of it's relevant.
Speaker:If they don't feel able to tell me that stuff that's relevant, then if
Speaker:I don't know it, I can't take it into account when I'm making a decision.
Speaker:And therefore my decisions are likely to be not quite as
Speaker:good as they could have been.
Speaker:So it's a lot about being civil means that someone in your team is able
Speaker:to share the information that they need to with you without thinking
Speaker:that they're gonna be penalized.
Speaker:Or is there something, have I got that slightly slightly
Speaker:No, no, no.
Speaker:That, that's, that's a large part of it.
Speaker:Making sure that people in your team feel that their
Speaker:contribution is welcome and valued.
Speaker:And when they say something that you don't agree with, as a leader,
Speaker:not denigrating them for it.
Speaker:One of the first people that I ever learned this stuff from was
Speaker:a guy called Magnus Harrison.
Speaker:And Magnus is the medical director across Leeds Trusts.
Speaker:But when Meg, when I first met Meg, I was a higher specialist trainee,
Speaker:and he was the clinical director for emergency medicine at Stoke.
Speaker:And Stoke was an amazing place.
Speaker:Totally overwhelmed many, many years before other places were
Speaker:overwhelmed, but utterly aspirational.
Speaker:And the consultants there were absolutely fantastic.
Speaker:And Meg used to say this thing when a trauma came in, and I learned it from, and
Speaker:it's this just before the trauma came in.
Speaker:And you say, okay guys, same rules as always.
Speaker:If you think that I'm doing something wrong or you think I've
Speaker:missed something, please tell me.
Speaker:If I don't acknowledge, you, keep telling me till I do acknowledge you, I need
Speaker:to know you are my check and balance.
Speaker:I am your check and balance.
Speaker:And if you tell me something I don't agree with, that's absolutely fine,
Speaker:but I still need to know about it.
Speaker:And what he was doing was setting up the environment for people to be able
Speaker:to speak, and he's actually giving them the responsibility as well.
Speaker:And I really like it.
Speaker:And I picked up, and I've used it myself for many, many years.
Speaker:And it has undoubtedly saved my bacon on a number of occasions and
Speaker:actually saved patients' lives as well.
Speaker:That ability for people to speak up.
Speaker:Because one of the things I realized when I came to England, and I, and I work in
Speaker:Coventry, one of the things I realized when I came to England is that my accent
Speaker:sounds quite hostile to a lot of people.
Speaker:Particularly I'm a wee that stressed.
Speaker:I, I sound like Groundskeeper Willie.
Speaker:And, um, people listen to me speaking and sometimes, I mean, I'm feeling
Speaker:nothing but love and pride and they think I sound like I want to stab them.
Speaker:And became acutely aware of just how much I had to moderate my language,
Speaker:change how I present myself and not get too Scottish excitable.
Speaker:It's interesting, isn't it?
Speaker:How even you know, one would think that in an emergency situation with a patient
Speaker:who is sort of dying before your eyes, that people would genuinely not care
Speaker:about the ramifications, about speaking up, about telling someone something.
Speaker:But you are saying that actually even in those situations where it
Speaker:is a life or death situation, how they think it's going to be received
Speaker:makes all the difference still.
Speaker:yeah, completely.
Speaker:Because this is about image management.
Speaker:I mean, that's what Amy Edmondson would talk about here.
Speaker:She, she was talking, she'd be telling you about image management.
Speaker:We're always image managing.
Speaker:We want to be seen as good and competent by the boss.
Speaker:We don't want the boss to be telling us that we're muppets.
Speaker:And it actually changes what people think about in those situations.
Speaker:Um, in a, in a different sphere.
Speaker:But within my n h s job, one of the things that happens when new junior doctors
Speaker:rotate into the department is that when they come and see me, the things that
Speaker:are most important to them are that they get the right diagnosis and they
Speaker:don't look like a fool in front of me.
Speaker:It's really important.
Speaker:We're always worried about looking like fools in front of folk.
Speaker:And actually, they're so obsessed with this, that for the first few weeks
Speaker:when new medical staff rotate into the department, they come and give me
Speaker:a history, they'll give me a really fantastic history, and then I'll say
Speaker:to 'em, okay, so you've told me about this pain and what's going on, all this,
Speaker:all this stuff that's going on for 'em, and how awful this pains is for them.
Speaker:What have you given them for analgesia?
Speaker:And if not.
Speaker:They've not, because what's worrying them when they go and see the patient is, is
Speaker:getting it right, getting it right for me.
Speaker:And one of my jobs is then to make it okay to not quite get it right, but also
Speaker:to make it really important that we get it right for the patient and getting it
Speaker:right for patients involves what's their main problem at this moment in time?
Speaker:What can we do to turn off, in this case pain, and how are we going to progress
Speaker:things going forward so that the patient understands what's going on and feels like
Speaker:an informed participant in their own care.
Speaker:that's really interesting.
Speaker:We, we focus as a human species on what is going to not make us look foolish, make
Speaker:us look okay, get people to accept us, and that includes status and it includes not
Speaker:being wrong and not looking like an idiot.
Speaker:And that is often trumps everything else.
Speaker:And it trumps the outcomes for other people.
Speaker:It trumps perhaps what our other behaviors is, are in other spheres of stuff.
Speaker:And I'm really interested in how that then interferes with our performance
Speaker:because as well as, like you said, focusing on the wrong things.
Speaker:Were like, we're not giving the patients analgesia when they needed to.
Speaker:But that surgical registrar that you told me right about right at the beginning,
Speaker:she literally couldn't think straight.
Speaker:And then, you know, fumbling, all thumbs, et cetera, et cetera.
Speaker:What happens to your brain when you are in that state?
Speaker:Why is it that we perform so badly when we do have those worries?
Speaker:This, what I'm about to say is a kind of combination of different
Speaker:theories that people have around this.
Speaker:It's how I understand it, and I can guarantee you that if you got
Speaker:into discussion about this with a neuroscientist, that they might go,
Speaker:That's a gross oversimplification, or he is on completely the wrong route.
Speaker:But the way that I see it is this.
Speaker:When somebody treats us in an uncivil way, something that feels
Speaker:disrespectful, may not be intended, but it feels that way to us, that is
Speaker:the thin end of the wedge of threat.
Speaker:It's the very beginning of us going, Oh, oh, you think it's
Speaker:okay to treat me like this?
Speaker:How else might you treat me?
Speaker:And when that happens, we, we don't think of it as threat.
Speaker:We are just aware of the discomfort of the interaction.
Speaker:So it's not, I'm not saying, Hey, I feel really threatened here.
Speaker:That's not what I get.
Speaker:I get some much more subtle emotion.
Speaker:And what then happens is two things.
Speaker:The first is that we begin to redistribute blood from our brain
Speaker:to our body so that our, our brains are literally getting less oxygen.
Speaker:But the other thing is what's happening inside our brains.
Speaker:And there, there seems to be some kind of obligation that whenever
Speaker:you discuss stuff like this, you have to mention the amygdala.
Speaker:Um, so I'm gonna randomly mention the amygdala, I think it sounds like science.
Speaker:Um, but what, the guys who look at this talk about is that instead of
Speaker:at the amygdala are our cognitive abilities being directed towards logic
Speaker:and understanding, they get diverted elsewhere towards, how do I need to behave
Speaker:to avoid this threat that's incoming.
Speaker:What that does is it squeezes down our bandwidth and it makes us literally
Speaker:less smart than we would've been.
Speaker:It probably also has, on an evolutionary level, saved our lives, because we are
Speaker:now in a position where we're going, I'm getting out the way of this, whatever
Speaker:this is, I'm getting out the way of it, and if we can't get out the way of
Speaker:it, our brain keeps sending more and more resources in the direction of, you
Speaker:know, you need to get away from this.
Speaker:But if you're stuck in theater and you're in a social situation,
Speaker:that is un inescapable, then what happens is you get driven further and
Speaker:further and further down that route.
Speaker:And eventually we know that human beings can go into a freeze state
Speaker:where they're literally just standing there unable to respond.
Speaker:And you know, people might not, not think that really happens, but I've
Speaker:seen it happen to people in the past.
Speaker:Um, and even if you've not had it to you in real life, you've probably
Speaker:had it in a dream, in a nightmare.
Speaker:Those nightmares where we are rooted to the spot, that's
Speaker:freeze, and it's horrible.
Speaker:And that's, but that's the, the far end of this when there's real overt threat there.
Speaker:The bit of this I'm interested in is that thin end of the wedge.
Speaker:It's the perception of incivility and what it does to us and why
Speaker:we over perceive incivility.
Speaker:But we absolutely believe that we've got it right.
Speaker:I mean, we believe with a high degree of certainty that when somebody else
Speaker:has treated us in a disrespectful way, that that was their intent and we're
Speaker:completely wrong most of the time.
Speaker:Yeah.
Speaker:When, when someone's short with us, it's because, oh, I've done something wrong.
Speaker:Rather than they are just knackered, they're just tired and they're just
Speaker:hungry, or something's distracted them and they're annoyed about something else.
Speaker:You know, we, we automatic.
Speaker:'cause I guess that's safer, isn't it?
Speaker:If you're talking in, in terms of survival, it's just safer
Speaker:to assume everyone's out to get you, then you can avoid it.
Speaker:But that doesn't work in, in the sort of society that we end up
Speaker:existing in now, because we end up seeing threat all over the place.
Speaker:Keeps you safe but not particularly happy and um, and rooted to the spot.
Speaker:That sort of fight, fight or freeze thing that happens.
Speaker:And that was really interesting to hear you talk about that.
Speaker:'cause I do talk about the makesit all the time and I've never quite
Speaker:understood why we get less empathetic.
Speaker:I understood that you make black and white decisions 'cause your
Speaker:blood is directed from the brain.
Speaker:But your explanation of actually, when I'm under threat, it's much better
Speaker:for my brain to be thinking about how to survive that threat and how to get
Speaker:myself outta the situation than empathy towards the other person, perhaps.
Speaker:That makes huge amount sense to me.
Speaker:Yeah, empathy is so hard to access when you're under threat because
Speaker:everything is about survival.
Speaker:Really interesting.
Speaker:When I first came across your work, actually, it was in the context of
Speaker:civility, saves lives, and if you are, say in the emergency department and you
Speaker:are in a recess room, there's a recess going on over there and you are working
Speaker:over here, but over there, someone's being uncivil, and it's not even to you, but
Speaker:it's to that team over there that affects your performance over here perform.
Speaker:Is that right?
Speaker:Yep, absolutely.
Speaker:Because we recognize that there's hostile behavior going on near us.
Speaker:We might need to get out the way of it.
Speaker:Uh, and what the work on this shows is that if you witness incivility between
Speaker:other people, on average, there's about a 20% reduction in your cognitive ability.
Speaker:That's probably dependent on a whole bunch of things.
Speaker:It's a really interesting piece of work done by a guy called Gadi Gilam.
Speaker:Gadi Gilam looked at the impact of witnessing incivility, but depending on
Speaker:where you sit on the empathy spectrum.
Speaker:So that's the Simon Baron Cohen work.
Speaker:It shows that people sit on a spectrum of empathy, and at one
Speaker:end, those wonderful, warm people that most of us like to be around.
Speaker:And down the other end, there's the cold fish.
Speaker:And it's no real surprise that if you're at that warm, empathic end,
Speaker:people seem to be significantly more impacted by witnessing incivility.
Speaker:Not directed at them, just witnessing incivility.
Speaker:And that's, I think it's really important in healthcare because what sort of
Speaker:people do we want to work in healthcare?
Speaker:And what sort of people are attracted to working in healthcare?
Speaker:It's usually empathic people.
Speaker:What that means is we have cultures where we accept people treating each
Speaker:other in an uncivil fashion, then it's probably gonna have more of an
Speaker:impact than that 20% I talked about.
Speaker:'cause that was across everybody.
Speaker:But we are probably selecting out people who are the top end
Speaker:of the empathy spectrum to work within the context of healthcare.
Speaker:One of the key things that we have to do, that we would like from the
Speaker:patients and relatives when they come into our organizations is trust.
Speaker:And there's a parallel here with what happens in banks.
Speaker:Now, you want to trust your bank, you want to trust your healthcare provider.
Speaker:If you go into a bank, if you've chosen to go into a bank and it's your bank,
Speaker:80% of people are already Nhat promoters.
Speaker:They have decided that they believe in this bank on witnessing a single
Speaker:uncivil interaction between two members of staff, no matter whether or not it's
Speaker:felt to be warranted, then the percentage of people who are Nhat promoters of
Speaker:that bank goes from 80% down to 20%.
Speaker:We really don't like it when the people around us are treating
Speaker:each other in a negative way.
Speaker:And I think that's important in healthcare as well because certainly when I was at
Speaker:the very early stages of my career and as a medical student, um, humiliation in
Speaker:front of patients was utterly normalized.
Speaker:It was completely acceptable and utterly normalized.
Speaker:And we allowed some pretty hideous behaviors at senior levels.
Speaker:And I know that people might say this, nothing's changed, but.
Speaker:Grief.
Speaker:It's an awful lot better than it was.
Speaker:Um, because some of the things that that happened were beyond the pale.
Speaker:And I was speaking to somebody about this, um, just a couple of weeks ago,
Speaker:and he was describing how when a certain surgeon walked onto the ward, and I
Speaker:knew who the surgeon was, as soon as he started this story, which I think is
Speaker:quite funny, uh, when a certain surgeon walked onto the ward, he used to hide
Speaker:in the stationary cupboard until he had gone, 'cause the guy was so scary,
Speaker:so odious, so difficult to deal with.
Speaker:And do you know what?
Speaker:I think the interesting thing there is I'll bet that if he knew the impact that
Speaker:his behavior had on the performance of his teams, this guy would've been horrified.
Speaker:I'll bet that he chose to behave that way because he thought that got
Speaker:the best outta people around him.
Speaker:And it's very easy to slip into this mode of looking at these guys and going,
Speaker:oh my God, that they're just, they're, they're just utterly awful human beings
Speaker:and they know it, and they're having this terrible impact on the people are in them.
Speaker:My experience of this is a lot of these guys have no idea that's how they're seen.
Speaker:None whatsoever.
Speaker:And they are continuing to behave in the ways that they had role
Speaker:modeled to them when they were, when they were medical students.
Speaker:And additionally, a lot of them are extremely judgmental.
Speaker:So they look at a situation and they make a negative judgment about the
Speaker:people involved in that situation and decide that they're lazy or stupid or
Speaker:don't care when actually in healthcare, these things are almost never true.
Speaker:I am really interested that you brought that up.
Speaker:'cause I was just thinking, you know, what about that surgeon who
Speaker:was asking that registrar the, the nitpicky questions are getting at her?
Speaker:You know, do people go to work to be assholes?
Speaker:I don't think they do, but they end up being that, and why do they do that?
Speaker:Because it's been modeled to them.
Speaker:But surely, you know, surely, you know, it's been modeled to you.
Speaker:You knew that that didn't get the best out of you and how much you hated it.
Speaker:But we can just continue to perpetuate that and to to do it to other people.
Speaker:Well, I knew it didn't get the best outta me, but I didn't know if it got
Speaker:the best out of other people or not.
Speaker:It wasn't until somebody had done their research and I felt in a position to,
Speaker:to go, Oh, it's not just me and it.
Speaker:And I think it's one of the strongest messages that, that we
Speaker:get out there is, you know, it's not just you, it's everybody.
Speaker:And it's not okay because you've got a whole team that's a whole
Speaker:team whose performance is dropping off, some of it precipitously.
Speaker:And the consequence of that is that patients are getting a raw deal.
Speaker:And actually, you know, as a leader, I'm getting a raw deal.
Speaker:I'm getting worse, less out my team than I could have got out my team.
Speaker:And one of the issues here is, is the curse of knowledge.
Speaker:Once you know that this stuff matters, you can't unknow it.
Speaker:And it's so blindingly obvious.
Speaker:Because not only is there science that supports it, but there's
Speaker:our own feelings that support it.
Speaker:It's so blindingly obvious once you know that behavior matters,
Speaker:that it's hard to unknow it.
Speaker:But actually, there's loads of people out there who, who have had the
Speaker:sort of leadership that we've just been describing, role modeled to us.
Speaker:And I, I'm all always thinking about whenever somebody says I'm
Speaker:going to go and crack the whip, you show me somebody in healthcare who
Speaker:needs to be stimulated any further.
Speaker:Most of the people who are working in healthcare are overstimulated.
Speaker:And overstimulated.
Speaker:People don't perform as well as people who are in the kind of golden zone.
Speaker:That's the whole Ys Dodson stuff.
Speaker:You push people too far, you are arousing too much.
Speaker:Their performance drops off.
Speaker:People don't need further arousal.
Speaker:What they need is somebody to reduce their stress levels so that
Speaker:they can start thinking again.
Speaker:But it is a kind of natural human thing when we think someone's
Speaker:not performing to, to kind of.
Speaker:get more emotional, more hacked off with them to show them that we're disappointed.
Speaker:But none of it helps unless they're super, super understimulated.
Speaker:But I don't think that exists in healthcare.
Speaker:I mean, I work in a place that's like some kind of hell version of Vegas.
Speaker:You know, the lights are on 24 7, we have no windows, half the clocks don't work,
Speaker:and there's people screaming and shouting and fighting and in pain, and there's a
Speaker:smell of blood and other bodily fluids, and it's horrifically overstimulating.
Speaker:And one of the things that helps to people to perform in that setting is trying
Speaker:to make them feel a little bit safer.
Speaker:Trying to make them feel seen, trying to let them know they're important,
Speaker:reducing the number of things that they have to do, not expanding upon it, and
Speaker:making them know that you've got them, you've got them if something goes wrong.
Speaker:And, the, the, the more experienced I get, the more senior I get, the more I
Speaker:see that the idea that I've got them if something goes wrong, is actually key.
Speaker:Um, Shirley my wife talks about a guy called Charlie Hendrickse.
Speaker:Now I've never met Charlie Hendrickse, but my God, that man
Speaker:has loomed large in my married life.
Speaker:Um, and Charlie Hendrickse, who may hear about this through this podcast, I
Speaker:think it'd be rather lovely if he did, but when she was a house officer, he
Speaker:sat her down and he was the registrar.
Speaker:And he said, if you're worried, I want to be worried.
Speaker:If you phone me in the middle of the night, I may be groggy, I may be a
Speaker:bit grumpy, but I will always come.
Speaker:And when I come, I will never be angry that you have called me.
Speaker:And that gave her a kind of safety net that allowed her to,
Speaker:to call him when she needed to.
Speaker:And she talks about how amazing it was that you would just
Speaker:stand at the end of the bed.
Speaker:You know those really sage people who stand at the end of the bed and sort
Speaker:of stare at the patients for a few minutes and they go, they've got this.
Speaker:You go, how could you know that?
Speaker:And then they turn out to be right?
Speaker:He was one of those guys.
Speaker:And I like that.
Speaker:I like that idea that, you know, you set people up to be able to ask you,
Speaker:you set people up to make the job as safe as possible and you know,
Speaker:compare and contrast the people who leave and say, I don't want you
Speaker:to call me and feel free to cope.
Speaker:Where's the safety there?
Speaker:Really, really difficult.
Speaker:And I mean, to me that is just the, the best leadership you could possibly
Speaker:have in these high stress environments.
Speaker:People that say, I've got your back.
Speaker:Call me anytime.
Speaker:And yeah, I, I mean, when I think back to the consultants I worked
Speaker:with, and there was one particular one who was completely odious and
Speaker:everybody, or he was rude to everybody.
Speaker:He was really not a nice person.
Speaker:But I think he genuinely cared about his patients, and I think he just
Speaker:genuinely didn't know how to behave.
Speaker:However, I think about the, it makes me feel really scared, the thought that
Speaker:anyone would go and give him some feedback about his behavior because I think they
Speaker:would just get eaten for breakfast.
Speaker:But if I was that person behaving, odious, I would a hundred percent
Speaker:want someone's give me the feedback so that I could change it.
Speaker:Um, I guess side, that's probably why I think the Civility Saves Lives
Speaker:thing is so amazing because it's not about criticizing you as a person.
Speaker:'cause how you are making me feel.
Speaker:It's about saying, no, actually, if you make me feel like this,
Speaker:then the behavior goes bad and then the patient outcomes are worse.
Speaker:So you're, you're looking back constantly to the patients.
Speaker:But how, how do we give this feedback to these.
Speaker:People who, like you said, there are a few psychopaths around, but most people don't
Speaker:go to work to give people a hard time.
Speaker:Most people have had a hard time themselves and they're
Speaker:just passing on the joy.
Speaker:But yeah, how do we give feedback so that actually lands?
Speaker:So, we have to take a step away from the feedback before
Speaker:we get on to giving feedback.
Speaker:The feedback needs to matter to the person that you're talking to.
Speaker:I, I could give you some feedback just now, Rachel, about your behavior and if,
Speaker:if you don't give a damn about how you're seen, you're not gonna give a damn about
Speaker:the feedback, it's not important to you.
Speaker:So I see part of the Civility Saves Lives stuff as being an arc.
Speaker:The first bit is making the argument that behavior matters.
Speaker:And just put out there for people to think about for themselves.
Speaker:I'm genuinely not trying to persuade anybody that behavior matters.
Speaker:What I'm doing is I'm, when I talk about this stuff, I'm just
Speaker:wanting people to have a wee think.
Speaker:They decide for themselves if this is important.
Speaker:I think most people end up deciding that it's important on their terms.
Speaker:Um, and there will be some who don't, and that's okay because that's people.
Speaker:But the first bit is to get people into the head space that behavior matters.
Speaker:And then when it comes to feeding back to people, so what we know is
Speaker:just getting people on board with the idea that behavior matters.
Speaker:Plenty people are insightful enough to change, to choose to change.
Speaker:So the Anna Baverstock work in maternity units in Somerset, where
Speaker:they took the percentage of people who believed that behavior mattered,
Speaker:over the course of a year in multiple sessions, they took the percentage
Speaker:of people who believed that behavior mattered from 60% to a hundred percent.
Speaker:In the same time, the percentage of people who said that they had seen
Speaker:uncivil behaviors in the preceding two to four weeks went from 70% to 50%.
Speaker:Now, I thought it would've gone up.
Speaker:I thought it would've gone up because I thought we'd have
Speaker:had this availability bias.
Speaker:We'd, we heard about incivility and we're gonna see it all over the shop.
Speaker:That's not what happened.
Speaker:And one of the explanations I have in my head for this is that there are people
Speaker:who are insightful enough to go, Yeah I'm not gonna behave like that next
Speaker:time and I'm just gonna bite my tongue.
Speaker:So we catch a few people there.
Speaker:In fact, we catch a lot of people there.
Speaker:And then we get the people who haven't got on board with this, or
Speaker:actually I think who mostly don't see themselves as being uncivil.
Speaker:And you know, none of us see ourselves perfectly all the time.
Speaker:You know, you and I will have interactions with this week with
Speaker:people and those other people will walk away feeling quite damaged by that.
Speaker:And we won't have a clue.
Speaker:We just will not have a clue.
Speaker:And the more it happens, the more it's normalized, the more that's just
Speaker:the way that Rachel or Chris interact with people and it becomes just us.
Speaker:And then you get this really dangerous statement in the workplace where
Speaker:people go, oh, you know, that's just Chris, but no one's told me.
Speaker:And I don't know how I'm coming across.
Speaker:So then we need to get into how you have these conversations.
Speaker:And it's interesting the, the way that you set that conversation up
Speaker:was you telling somebody who had been uncivil to you about how you felt.
Speaker:And that is a phenomenally high level feedback skill,
Speaker:like really, really difficult.
Speaker:And the reason that it's really difficult is say it's me and you, and I speak to
Speaker:you, and I leave you feeling like crap, especially if I'm the boss, if you have
Speaker:to come and give me feedback back, we know that the person in your position
Speaker:believes that I deliberately did it.
Speaker:That means if you come and give me feedback, what you're saying
Speaker:is, Chris, so you know how you tried to hurt me the other day.
Speaker:Well, it worked, please don't do it again.
Speaker:That's empowering your aggressor.
Speaker:You have to be an idiot to want to do that because, or, or just a masochist.
Speaker:So we don't have those conversations.
Speaker:Because actually much as we want to have that degree of personal mastery, we want
Speaker:to be able to go and say, yeah, this is how it is to somebody, actually, we're
Speaker:the wrong person to do it, because when we do go into those conversations, we
Speaker:carry a lot of emotional baggage with us.
Speaker:And that emotional baggage arouses us, closes our bandwidth, stops us being the
Speaker:best version of ourselves, and it means that we often get into confrontational
Speaker:interactions, or we are so meek and mitigating that the other person hasn't
Speaker:a clue what we're trying to say to them.
Speaker:So the best evidence on this, and this makes a bit more messy,
Speaker:but it's much more effective.
Speaker:The best evidence on this is the right person to have the conversation
Speaker:is not you, it is somebody else.
Speaker:Preferably a peer of mine who then comes and has the conversation with me.
Speaker:And I'm going to talk a little bit for the next minute or two about
Speaker:what that conversation looks like.
Speaker:And the conversation looks like this.
Speaker:It's a conversation that has three overarching meta principles.
Speaker:The first one is this, and it's really counterintuitive.
Speaker:The person having the conversation is going to care about the
Speaker:person they're speaking to.
Speaker:Because people who are damaging others in interactions are often
Speaker:quite damaged and hurting themselves.
Speaker:Also, if they don't know, This is gonna be a difficult thing to hear.
Speaker:So we are gonna care about them in that conversation.
Speaker:The second thing we're gonna do is we are going to have the conversation
Speaker:with zero judgment about intent.
Speaker:We literally don't know the intent of the person who is speaking.
Speaker:And the third bit is we are going to deliver the professional privilege of
Speaker:a package of information, of knowing how we are perceived or that person
Speaker:is perceived, which is a really long way of saying, telling, telling
Speaker:someone how somebody else felt.
Speaker:And the way that we teach people to do this, it is three step technique.
Speaker:It has those three overarching things in the first place, but the
Speaker:three step technique goes like this.
Speaker:Check in, raise the flag, land the information.
Speaker:And the check-in is like this.
Speaker:I'm, I'm gonna usually hear Rachel, but you don't need to say anything okay?
Speaker:So, the situation is now that Rachel has been involved in something
Speaker:and Rachel's, someone's pretty devastated at the other end of it.
Speaker:Uh, Rachel's blithely going on through life as Rachel does, um, boiling
Speaker:frogs and doing all the rest of it.
Speaker:And I'm gonna go and speak to you.
Speaker:And I, and I come and speak to you and it would be as soon as is practical,
Speaker:but also at the right time for you.
Speaker:And the conversation, the first bit is check in and I say, Rachel, how are you?
Speaker:No, really, how are you?
Speaker:And I pause and I wait.
Speaker:And you might well say you're fine, or you might as happened
Speaker:to me the last time I did this.
Speaker:Um, you might then speak for eight minutes without stopping,
Speaker:'cause you are not all right.
Speaker:And very occasionally, and this is really rare, very occasionally, the
Speaker:person you're speaking to is so not all right, that you don't go any
Speaker:further with the conversation, just say to them, listen, I think you
Speaker:need to go and speak to your line manager, your GP, occupational health.
Speaker:'cause you're not in a good place.
Speaker:And very, very occasionally, I I will say, and I'm gonna have a word
Speaker:with your, with your line manager.
Speaker:'cause I, I'm worried for you.
Speaker:But that's rare.
Speaker:That's really rare.
Speaker:The, the vast majority of people are a bit hacked off.
Speaker:There's a lot of crap going on and you know, they tell you a bit about that.
Speaker:The second bit is raising the flag.
Speaker:And it would go like this.
Speaker:It'd go so Rachel, what happened with Sam yesterday in the department?
Speaker:Now I'm raising a flag.
Speaker:It's pretty clear something happened with Sam.
Speaker:And you might say, oh, you know what?
Speaker:I made this joke.
Speaker:And I realize afterwards it could have sounded, it could have sounded
Speaker:racist, but I don't think she heard.
Speaker:And I can say, Hey, she heard.
Speaker:At which point, we know a lot of people move into what's
Speaker:called service restoration mode, where they go, Chris, thanks.
Speaker:Do you mind if I leave now I need to go and speak to her.
Speaker:Because people don't wanna be that person.
Speaker:Not everybody does that, but a lot of people do.
Speaker:But most people will go, yeah I spoke with Sam, normal conversation.
Speaker:Yeah, not nothing.
Speaker:Nothing happened in it because it was a normal conversation
Speaker:for the person I'm talking to.
Speaker:So I've checked in, I've raised the flag, and now I'm gonna land the information.
Speaker:Really, really carefully constructed and very simple, and it goes like this.
Speaker:So Rachel, after you spoke with Sam yesterday, Sam was really upset and I
Speaker:know you'd want to know that is it from my perspective, that's a full stop.
Speaker:Now, what will happen then is the other person will speak.
Speaker:They always speak.
Speaker:They want to uh, they want to say what happened from their perspective.
Speaker:They want the chance to talk.
Speaker:That's all cool.
Speaker:The important thing has been done.
Speaker:This person now has that piece of information that they can choose
Speaker:what they want to do with it.
Speaker:Because if you don't know, how can you choose to behave
Speaker:differently the next time?
Speaker:And that sounds soft, doesn't it?
Speaker:Is it, what I've just described sounds kinda soft, but it's built on work by a
Speaker:guy called Gerry Hickson in Vanderbilt, uh, Vanderbilt's in Nashville, and I.
Speaker:A few years ago before Covid and you know, before we used things like
Speaker:Zoom and Teams and Riverside to have conversations with people, um, we used
Speaker:to go to see people or phone them up.
Speaker:And I had an entire summer holiday designed around a one hour meeting with
Speaker:Gerry Hickson in Nashville, in Vanderbilt.
Speaker:And I'm not a good man to be married to.
Speaker:I think that's pretty obvious from that statement.
Speaker:Um, however, that being said, you know, there was also a, a family wedding
Speaker:going on down there, so, you know, everybody got something out of it.
Speaker:Um, and I know what I got out 'cause I got an hour, an hour with Gerry Hickson
Speaker:and it was utterly, utterly worth it.
Speaker:We sat down and he talked, so they, he, they're the pioneers of this.
Speaker:And he discussed some of the data.
Speaker:At that point they had 37,000 of their equivalent of that
Speaker:cup of coffee conversation.
Speaker:After a single cup of coffee conversation, only 2000 people went
Speaker:on to behave the same way again.
Speaker:And that 2000 had another cup of coffee conversation.
Speaker:But this time, with the 360 describing from the people were in, what it was
Speaker:like to work with them, because I guess a few of those guys goes, ah, I
Speaker:was just one person being a snowflake.
Speaker:But then they got the 360, which the organizations paid for,
Speaker:and then they were down to 267.
Speaker:Those 267 were the very first level at which HR or the line manager got involved.
Speaker:The rest of this was done at a peer-to-peer level.
Speaker:I think that's absolutely incredible.
Speaker:This idea that by packaging the information in a way that people can
Speaker:hear, people just choose to change if they think changing is worthwhile.
Speaker:So many questions.
Speaker:Chris.
Speaker:That is a complete revelation to me.
Speaker:Um, just that Gerry Hickson's work, was that specifically in
Speaker:healthcare or was that across lots of different organizations?
Speaker:His 37,000.
Speaker:Were all doctors, often regarded as being the most difficult
Speaker:group of people to change?
Speaker:Yeah, totally.
Speaker:that, that third thing of your three steps land the information, the, the very
Speaker:short thing, Sam was upset and I knew you'd want to know, and then you just
Speaker:stop so you don't tell 'em anything else.
Speaker:Or if they then start asking, well, why, what did I do?
Speaker:I don't, can you then give more information?
Speaker:Well it depends what you know.
Speaker:Um, so, after you spoke with Sam yesterday, Sam was really upset
Speaker:and I know you'd want to know.
Speaker:They might well want to understand that, and I get that.
Speaker:The important thing is that Sam was upset because we know that
Speaker:upset people don't perform so well.
Speaker:And what might happen there, what, what sometimes happens is that people
Speaker:will ask lots of questions to try and understand it a bit better, and they will
Speaker:sometimes go, that's a lot of rubbish.
Speaker:So go fine, but Sam was still upset.
Speaker:And you furnish people with the knowledge of somebody else's
Speaker:emotion, and it's not really my place to explain why they were upset.
Speaker:Arguably, if this person wants to know, then that the, the right place, the
Speaker:best place to have a conversation with someone where they're saying sorry for it.
Speaker:Now, I know that occasionally people don't say sorry, but the
Speaker:vast, vast majority of people do.
Speaker:Because we really don't like hurting our fellow person.
Speaker:That is there, there aren't many people out there who are, who
Speaker:are genuinely sadistic like that.
Speaker:In fact, you that you can measure the percent of people who abuse power.
Speaker:Um, and it's about 4% of people.
Speaker:Two to 4% of people state that they do things 'cause they have the power
Speaker:to do them, so they might as well.
Speaker:But that's pretty sort of psychopathic, sociopathic, uh,
Speaker:position to take on things.
Speaker:Okay, so you've given them feedback and go Sam was upset, I knew you'd want to know.
Speaker:What happens to that person goes, oh my gosh, they were upset.
Speaker:Ugh.
Speaker:How do I, and you don't know exactly why they're upset and you'd be, um,
Speaker:uh, we use this concept of being over the net which is when you make
Speaker:assumptions about what the other person's thinking, you've, you know,
Speaker:you know, you don't necessarily know.
Speaker:You can assume, well, it might have been 'cause of this, but
Speaker:you don't necessarily know.
Speaker:But what's the person that's you are talking to, the person that's done the
Speaker:upsetting doesn't know and they don't really have the skills to find out.
Speaker:'Cause it's actually, it's, I think it's quite an advanced skill to go to
Speaker:someone and go, and this is something I'm trying to really learn at the
Speaker:moment go, can I just check in?
Speaker:'cause I noticed that when I said this, you responded in, in, in, in a, in a way
Speaker:that I was quite surprised that, can I just check what was going on for you?
Speaker:And the story in my head is, I might have done this, but can I, you know,
Speaker:again, that takes quite a lot of courage and, and a bit of skill to do that.
Speaker:And we are really rubbish at reading other people's facial expressions.
Speaker:Totally.
Speaker:So it becomes about, and I'm keeping this pretty high level, it becomes about
Speaker:curiosity, not trying to guess what the other person's feeling, asking them.
Speaker:So, many, many years ago, I was having literally one of the worst
Speaker:days of my life as I'm one of the worst week, weeks, months of my life.
Speaker:It was awful.
Speaker:I was clinging on by my fingertips.
Speaker:And I arrived at work and something really crappy happened on my way to work,
Speaker:which put me in an even worse place.
Speaker:And I arrived at work and we were doing long shifts, 11, 12 hours.
Speaker:And on my own for that period of time with a queue of doctors
Speaker:coming to ask me questions.
Speaker:And with the way it works for us is I stand here and facing me as
Speaker:the senior nurse in the department, and we both have a computer screen.
Speaker:And we talk to each other over our computer screens.
Speaker:And the day was brutal.
Speaker:It was a weekend, it was a Saturday, it was a brutal day.
Speaker:And we were getting seven o'clock and the nursing shift was changing over.
Speaker:And my colleague, my nursing colleague, um, said, can I have a word?
Speaker:And I said, Okay, yep, fine.
Speaker:Let's have have words, see what's going on.
Speaker:And he got me around the corner and he said to me, do you know, I've gotta
Speaker:tell you, this has been one of the worst shifts I've ever done, and it's
Speaker:been one of the worst shifts I've ever done because I've had to stand here
Speaker:and watching you with that smug look on your face the entire bloody day.
Speaker:And I want you to know how crap it was for me.
Speaker:And it was literally all I could do to not cry.
Speaker:And we are just rubbish at working of what's going on in somebody else's life.
Speaker:We are so bad at it.
Speaker:And when we take judgment into it, when we decide that we know how
Speaker:somebody else is feeling, we're just wrong lots and lots of the time.
Speaker:And if he had stopped and paused or if I'd chosen to share at the beginning of
Speaker:the shift, if we'd stopped and paused and checked in with each other, we might well
Speaker:have had a much better day, but we didn't.
Speaker:And that at the end of the day, his assumption was I was just being smug
Speaker:about stuff, which it is a weird accusation 'cause I'm not sure how often
Speaker:I feel smug, but it's not very often.
Speaker:So interesting.
Speaker:So, so just getting curious.
Speaker:So, so if, if someone needs the skills to find out what they've done, just
Speaker:literally going up to someone going, I can, you just fill me and I, you
Speaker:know, I, I, I, I think I may have upset you, I'm, I'm curious, did I,
Speaker:and what was the cause and what, what, what's going on in just being curious?
Speaker:did I do?
Speaker:Yeah.
Speaker:What did I
Speaker:Just asking what did I do?
Speaker:I, and not having the conversation to prove that you didn't do
Speaker:it because they got upset.
Speaker:They, they, they own that emotion.
Speaker:it's a case of being curious to understand how they experienced it.
Speaker:Do you need Sam's consent to go and have that conversation with,
Speaker:with the person that upset her?
Speaker:Okay, so that's a really interesting question.
Speaker:'cause a lot of the time, once people have talked about it, they don't want
Speaker:some, once they talk, they've kind of got it off their chest and they go,
Speaker:I don't want to tell it to anyone.
Speaker:The way that we advise is that there is a commitment to having the conversation.
Speaker:As soon as we are having first conversation, there is a commitment
Speaker:to tell the supposed perpetrator, because otherwise how can they know?
Speaker:So yeah, there's a commitment to having the conversation.
Speaker:How can they know?
Speaker:How can they change?
Speaker:Now, as you were saying this, by the way, I just think this is absolutely brilliant.
Speaker:I can see how this would be so helpful, but in my mind I'm having
Speaker:a, a small reaction because we teach people a lot about the drama
Speaker:triangle and about getting outta rescuer, victim, persecuted mentality.
Speaker:There's a bit that I love at the moment, um, called the 15 Commitments of Conscious
Speaker:Leadership, all about being a conscious leader, being self-aware, um, and not
Speaker:reacting, not being in your amygdala zone, but actually sort of being above the line.
Speaker:And there's also books about called Radical Candor and all
Speaker:this thing about you going to have these conversations with people.
Speaker:And I slightly worry with this, that you'll get lots of people in rescue
Speaker:mode going, oh, no, don't worry.
Speaker:You don't need to go there.
Speaker:I'll go and have a word with them.
Speaker:Don't worry.
Speaker:You, you don't need to.
Speaker:And, and a lot of the stuff we talk about is empowering people to have
Speaker:those conversations themselves.
Speaker:But it makes absolute perfect sense that it's so hard to have a conversation
Speaker:when you've been upset about something.
Speaker:So maybe it's that, that upset power balance thing.
Speaker:But how do you avoid getting into the rescuer victim role
Speaker:when you are doing this?
Speaker:I'll go and have that conversation on your, it's not really on your, it's,
Speaker:I was about to say on your behalf, but you're not having it on their behalf, are
Speaker:you're having it on everybody's behalf,
Speaker:Yes.
Speaker:Yeah.
Speaker:Okay.
Speaker:I think, I think it helps to step away from Karpman for, for understanding the
Speaker:relationships that are going on here.
Speaker:You're not a rescuer, you're not a victim.
Speaker:You're a messenger, you're, you are giving somebody a piece of information that they
Speaker:have a professional right to know, and you're handing it to them because then
Speaker:that knowledge could literally result in other people having their lives saved.
Speaker:Because if we go through life leaving trails of devastation behind us and
Speaker:the people that we work with, then the consequence is that our patients
Speaker:get worse care and we are there to provide the best care that we can.
Speaker:So in my head, this is not about the drama triangle.
Speaker:This is a different relationship and it's a, it's a more adult adult relationship's.
Speaker:And it's not about rescuing, it's about informing in the most kind,
Speaker:compassionate way that we can because it is not easy to hear this kind of stuff.
Speaker:None of us enjoys hearing that we left other people distressed.
Speaker:We don't like that in the fir.
Speaker:Well, very few of us enjoy that.
Speaker:But particularly if we know that that means that our patients are getting
Speaker:less good care, that's even worse.
Speaker:So compassionate delivery of a package of information that people have a
Speaker:professional right to know about.
Speaker:And I love that 'cause you've reframed it from what you're not doing.
Speaker:You're not going and rescuing the victim who's been hurt.
Speaker:You've noticed the behavior.
Speaker:And it's Notre, it's not really about anymore.
Speaker:It's not about the victim of the behavior anymore.
Speaker:It's about the person that did that behavior.
Speaker:It's about telling them, giving them feedback about the behavior so
Speaker:that they can change for the future and keep everybody safe, right?
Speaker:and it's also something else.
Speaker:It's that there may have been no intention, none whatsoever.
Speaker:In fact, sometimes the person didn't even do the behavior that the
Speaker:other person's taking offense at.
Speaker:It didn't happen that way.
Speaker:But this is all about how we experience life as human beings.
Speaker:And we don't all experience it the same way.
Speaker:And we get stuff wrong.
Speaker:And we think, we think that we've, we have the, the full
Speaker:truth, but of course we don't.
Speaker:It doesn't matter.
Speaker:On one level, this is the level that it doesn't matter on.
Speaker:If we have an interaction, I'm left feeling less at the end of that
Speaker:interaction, the consequences that my performance is dropping off.
Speaker:We don't want that in our, in our teams.
Speaker:And there's a just an infinite amount of subtlety to, to this once you get into
Speaker:it because it's actually about knowing the individuals that we work with and
Speaker:knowing what's the right way to interact with one person or another or another.
Speaker:And yeah, sure, we should be civil to each other, but there are still
Speaker:different words and different behaviors that trigger different people.
Speaker:And you know, one of the things I learned coming to England is that there is, there
Speaker:is language that I would use in Scotland amongst my mates that you guys, you guys
Speaker:are so soft, you're horrified by it,
Speaker:Oh yeah.
Speaker:You must never anything directly, Chris.
Speaker:Well, yeah, no, I mean, there, there are words that you can, there's a
Speaker:word that I have learned is apparently a dreadful word that begins with
Speaker:C, and it's a very small word.
Speaker:And apparently it's a really bad word in England, in the groups that
Speaker:I function with, uh, or some of them in Scotland, it means person.
Speaker:Literally that's what it means.
Speaker:And if anybody doesn't believe me, you can look this up.
Speaker:So if you were to go and look up online, if any C, and you all
Speaker:know what the word is, if every C says it, does any C mean it?
Speaker:And there are these brilliant clips of Scottish people chatting
Speaker:on the news or phoning into shows using this word to mean person.
Speaker:One of them's, one of them's on the national news, and it's
Speaker:not until people phone and go, you do know what he just said.
Speaker:And, and there's, they're literally devoid of malice when they're using the word.
Speaker:And some of this is about understanding the cultural context of what's
Speaker:acceptable, what's not acceptable, and bending and flexing to be, to be
Speaker:appropriate in, in a different culture.
Speaker:And you know, also letting culture evolve and change.
Speaker:And it's not about forcing everybody to be exactly the same way, but also
Speaker:understand, understand that some of the things you might say or do
Speaker:might cause distress and offense.
Speaker:And that's not my purpose in my use of language most of the time.
Speaker:Yes, yes.
Speaker:You choose, choose your battles and all that.
Speaker:I mean, there, there's, there's a few things that, that strike
Speaker:me as, as why this is so helpful.
Speaker:Firstly, is that what you are when you are raising that, just to let you know,
Speaker:Yeah, what happened because Sam was upset.
Speaker:I thought you'd like to know.
Speaker:I think a lot of the time we don't give the feedback well 'cause we don't
Speaker:wanna upset the person, but because we don't, we don't know what, we'll
Speaker:then say, what advice would we give?
Speaker:You know, and this is how I think you should change, or this
Speaker:is what you should do instead.
Speaker:But if you don't have to do that, then great.
Speaker:All you're doing is saying, actually that happened.
Speaker:Thought I'd thought I'd flagged that up for you.
Speaker:So that makes it much, much easier.
Speaker:Like, and literally anybody can tell someone that they've upset somebody, that
Speaker:they've noticed somebody else was upset.
Speaker:You don't need to be skilled.
Speaker:You could just go and say, that happened.
Speaker:I don't know, you know, you go find out why yourself, but I'm just saying it did.
Speaker:One of the things that.
Speaker:We know about this, and this is uncomfortable, is that as leaders
Speaker:we generally are more accepting of criticism If we invite it.
Speaker:Uh, uninvited criticism or uninvited challenge is difficult.
Speaker:Invited challenge.
Speaker:We feel like we have a degree of control over it.
Speaker:And that's back to that thing that Magnus taught me to say in trauma
Speaker:about, you know, if you think I've missed something or you think I've
Speaker:got something wrong, please tell me.
Speaker:I was talking a few weeks ago to a surgeon who, he admitted this in a, in
Speaker:a group of folk, and, and you know what?
Speaker:It's, it's uncomfortable what he admitted, and I would entirely resonate
Speaker:with it, and it's, it's this, he said, I really like people to call
Speaker:me by my first name in theater.
Speaker:And everyone calls each other by a first name.
Speaker:And I like it when my team call me by my first name.
Speaker:I really dislike it when somebody comes in who's not being part of that
Speaker:team and isn't part of that group who comes in and uses my first name.
Speaker:And it's very clear that's not right, okay?
Speaker:And yet it is the human condition that we don't enjoy somebody
Speaker:assuming they can do that.
Speaker:I don't enjoy it.
Speaker:If I'm running trauma and somebody comes in and assumes they can come
Speaker:in and criticize what I'm doing.
Speaker:You know, it's like, who the hell are you?
Speaker:Out.
Speaker:You know, get him a room.
Speaker:Um, because actually I find that destabilizing.
Speaker:And I suppose part of that is me trying to control my own environment so
Speaker:that I'm not overstimulated by it and that I'm able to perform at my best.
Speaker:And somebody else coming in and challenging around that can be difficult
Speaker:if I've not been in control of that.
Speaker:And, you know, maybe that makes me, maybe that makes me a wee bit small.
Speaker:I don't know.
Speaker:but that's my experience of it.
Speaker:think that makes you human, Chris, because if, if I may call you Chris or Dr.
Speaker:Turner.
Speaker:Yeah.
Speaker:Yeah.
Speaker:No, uh, emergency medicine, very flat hierarchy, you know.
Speaker:I, I think that is just a human condition, isn't it?
Speaker:Because nobody likes, well, criticism gets our backs up, whether it's well intended,
Speaker:whether it's right or not, because again, it's just that threat thing, isn't it?
Speaker:So if it's uninvited, it just catches you unawares.
Speaker:For a start.
Speaker:If it's un, if it's invited, then you, you could brace yourself for it.
Speaker:And you know, and you know that it's got good intentions behind it as well.
Speaker:So there's, it's completely different kettle of fish.
Speaker:Um, but what if you are that person?
Speaker:Because it's, it's really hard, you know, I'm sure everyone listening
Speaker:to this podcast is not only thinking about people that they need to go
Speaker:give feedback to about their behavior, but thinking, oh my goodness,
Speaker:and then I know I am that person.
Speaker:And the problem is when we get that feedback that we want, because there's
Speaker:no way I want everyone to go through life going, well, that's just Rachel.
Speaker:I want people to come.
Speaker:So I'm not that, that's just Rachel.
Speaker:I'm thinking of some people that probably would just go, that's just
Speaker:Rachel, mainly my close family.
Speaker:Anyway, um, you want, you want that feedback, but when it comes,
Speaker:it can be really devastating.
Speaker:And then I'll m does flare up.
Speaker:So how do we manage ourselves?
Speaker:How do we, how do we not not be that person that responds really
Speaker:badly, but we are the person who is inviting criticism and, and,
Speaker:and dealing with it when it comes?
Speaker:So we're going to have a response.
Speaker:We're humans.
Speaker:We're gonna have a response.
Speaker:Of course, you're gonna have a response.
Speaker:You didn't wanna hurt people.
Speaker:You've been told you've hurt someone.
Speaker:So we're gonna be disappointed in ourselves.
Speaker:The point is that us having our own reaction about our self worth,
Speaker:this is not somebody else telling us that we've been bad, the the
Speaker:transaction totally different.
Speaker:This is an internal monologue, an internal understanding.
Speaker:And I've had it done to me twice.
Speaker:Twice in the last 10 years.
Speaker:I've had feedback delivered to me in something resembling
Speaker:the way I've just described.
Speaker:And on both occasions, I had precisely zero knowledge that I had hurt somebody.
Speaker:And on both occasions it gave me the opportunity to go and speak
Speaker:with that person and to resolve it.
Speaker:And on both occasions I ended up having very good working
Speaker:relationships with those people.
Speaker:And one of the things we know about people who say, sorry, and the act of saying
Speaker:sorry, is that lots of folk hate it.
Speaker:They're, they're just at test saying, sorry.
Speaker:But the truth is that if we screw up with somebody before we screw up with somebody,
Speaker:they see us at say a level five in terms of how much they like or respect us, we
Speaker:screw up with them, we go down to three.
Speaker:And these, by the way, I'm just giving numbers 'cause people will
Speaker:be listening to this as a podcast.
Speaker:These are made up numbers.
Speaker:All right.
Speaker:This is the illusion of, of science.
Speaker:This is truthiness.
Speaker:I'm just, I'm just putting this out there because it makes more sense.
Speaker:So we started as a five.
Speaker:We were a dick, we're down to a three.
Speaker:Somebody tells us that we've screwed it up, we go and say, sorry, now
Speaker:we're not a five, now we're a seven.
Speaker:We rise in people's estimation.
Speaker:The act of saying, sorry, it's hugely powerful, hugely pro-social.
Speaker:It sees others, it recognizes flaws in ourselves and it says we can be
Speaker:better, and people really like it.
Speaker:And I am not suggesting for one second that people go out and screw up so
Speaker:that they can say sorry and be seen in a better light by other people
Speaker:because that'd be highly manipulative.
Speaker:But when we do screw up, you go and say sorry, people think you're an even better
Speaker:human being, and I'm done with that.
Speaker:That's a, that's a pretty big payoff, um, for a small act of contrition.
Speaker:Yeah.
Speaker:And I can definitely think of times in, in my career where, yeah, I did muck up
Speaker:and I thought I'd completely mucked it up.
Speaker:I'd like lost my temper or something like that.
Speaker:And I went to that person.
Speaker:I apologized and they were like my best mate afterwards.
Speaker:It was amazing.
Speaker:It's, it's amazing the effect it has on the relationship.
Speaker:It's, it's, it's, it's weird,
Speaker:Yes, it?
Speaker:is indeed.
Speaker:Weird.
Speaker:It's weird,
Speaker:did that happen?
Speaker:You know,
Speaker:like, how are we, like, I was really awful to that person and
Speaker:now like they Yeah, it is, it is.
Speaker:It, it is really uncanny.
Speaker:but the other thing I have noticed is, and this happens to me recently and we,
Speaker:I'm quite upset on this podcast about these stories of guilt and shame and
Speaker:I ought to, and I'm such a bad person.
Speaker:I thought I'd upset someone recently and I was really beating myself up
Speaker:about it and I noticed it that they reacted slightly offhand with me
Speaker:and, and I was like, I, I thought I can't go and I can't speak to them.
Speaker:What if I, what if they tell me I, you know, what if they really come
Speaker:back with criticism, et cetera?
Speaker:But I did, and I went to speak to them and I had upset them.
Speaker:I had, and they, they said, yes, you did, and they told me and I apologized
Speaker:and it was like, it was like a drain clean had gone down the drain and just
Speaker:the relationship was much, much better.
Speaker:But the thing, the reason I'm telling this story is the story I was making
Speaker:up in my head about how awful it would be if I actually had done
Speaker:that thing I thought I had done was actually much worse than receiving the
Speaker:criticism that I actually had done it.
Speaker:Does that make sense?
Speaker:The shame I felt before we actually, it was in the open, was much,
Speaker:much worse than the shame when I actually knew and I could apologize.
Speaker:A hundred percent that.
Speaker:We still fear it though.
Speaker:We do.
Speaker:It's, it's hard.
Speaker:It's my, it's my quest to be able to do this without, without telling
Speaker:myself all those awful shame stories.
Speaker:'Cause we all muck up, don't we?
Speaker:Particularly when, when you work in environments where literally
Speaker:people are dying and, and life turns on, you know, split decisions
Speaker:and all that sort of stuff.
Speaker:So, Chris, with all of this, what if you had to distill this advice into three
Speaker:top tips for people, what would they be?
Speaker:I would say be kind to yourself.
Speaker:You're gonna screw up.
Speaker:Everyone screws up.
Speaker:Own it when you do.
Speaker:Find the people who let you own it without weaponizing it.
Speaker:And when other people screw up, let them own it, but don't judge them on it.
Speaker:Support them through it because nobody wants to screw up.
Speaker:And the final thing I would, I would ask people to think about is just
Speaker:really quickly, what's your theme tune?
Speaker:What music do you want people to hear when you walk in the door?
Speaker:Choose your music.
Speaker:And then decide how you need to behave.
Speaker:If you want people to hear that music when you walk through the door.
Speaker:I love that.
Speaker:Do you mind me asking, what's your theme tune?
Speaker:Uh, mine's really embarrassing 'cause the people who wrote it
Speaker:are a bit of a pair of clunkers.
Speaker:Um, which means I, I now can't tell you because I'll get, nah, Right Said Fred.
Speaker:Deeply Dippy.
Speaker:I love it.
Speaker:For a minute.
Speaker:I was thinking it's, I'm too sexy for my shirt.
Speaker:No, no, no, no.
Speaker:Definitely Deeply Dippy.
Speaker:Yes, I'm very, very, very, very sure.
Speaker:We now know you are next.
Speaker:The next time you do like a TEDx talk, we now know what's
Speaker:gonna be playing as you walk on.
Speaker:So, so, so, so helpful.
Speaker:Thank you so much for being on the podcast.
Speaker:If people wanna find more about, you know, the Civility Saves Lives
Speaker:or get in contact with you or anything, how, how can they do that?
Speaker:civilitysaveslives.com is the website.
Speaker:Um, and if you write to us there, everybody gets answered,
Speaker:usually reasonably quickly, but everybody gets answered.
Speaker:And then one of us has a chat with folk.
Speaker:It's usually me if people wanna talk about this stuff.
Speaker:Um, so you see us get us there and yeah.
Speaker:And we're on Twitter at, at civility Saves.
Speaker:thank you.
Speaker:So we'll put all those links in the show notes, including links
Speaker:to the TED Talks as well, in case people wanna wanna watch those.
Speaker:And thank you so much for your time and I think we're gonna have to get
Speaker:you back at some point, if that's all right, to talk about this more because
Speaker:I'm sure we'll have much more, many, many more, more questions with people.
Speaker:So thank you so much for being on
Speaker:Thank you Rachel.
Speaker:Thanks for listening.
Speaker:Don't forget, we provide a self coaching CPD workbook for every episode.
Speaker:You can sign up for it via the link in the show notes.
Speaker:And if this episode was helpful, then please share it with a friend.
Speaker:Get in touch with any comments or suggestions at hello@youarenotafrog.com.
Speaker:I love to hear from you.
Speaker:And finally, if you're enjoying the podcast, please rate it and leave
Speaker:a review wherever you're listening.
Speaker:It really helps.
Speaker:Bye for now.