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Can You Speak Up? I Can’t Hear You

Can You Speak Up? I Can’t Hear You

Maureen Dowd recently wrote an Op Ed piece in the New York Times entitled Giving Doctors Orders, in which she discusses the importance of speaking up and asking your doctor to wash his or her hands in front of you prior to beginning an examination. She cited CNN reports and book authors who all recommend saying something to your physician if you don’t see them wash their hands with your own eyes. Sounds like a good idea, right? So what’s the problem? Well there are actually two problems: 1) getting people to start speaking up, and then 2) getting them to keep doing it. I have seen this all too often in working with clients, particularly on the safety side (but also on the non-safety side). Dowd’s article echoes one of the biggest challenges employees at all levels face, speaking up and giving feedback to others about their behavior, particularly those in authority.

Why is it so important for people to speak up in the moment when they see someone either engaging in a desired behavior (e.g., doctors washing their hands in front of patients) or an undesired behavior? And, why do people sometimes remain quiet even when they observe someone engaging in behavior that could (or will) negatively impact others or themselves? Why won’t they speak up more often, and what will it take to get them to start speaking up and doing so on an ongoing basis? The answer to all these questions is consequences.

First and foremost, it’s important to speak up in the moment (rather than saying something to the doctor later as you’re leaving the office) because the immediacy of the feedback increases its effectiveness.  By interrupting the at-risk behavior and helping the person begin practicing the correct behavior now, it also holds the performer personally accountable for doing the correct behavior.  Unfortunately the consequence history of people who typically say nothing when they should is one of being punished or penalized when they have given feedback in the past or they have ‘rules of conduct’ about respecting authority learned at an early age. The rule might be “respecting doctors means not questioning them about their practices”. In Dowd’s example, for instance, the negative consequences for asking your doctor to wash his or her hands might have been the doctor dismissively telling you his or her hands are already clean and even anticipating a sideways look that screams, ‘You dare to challenge me?”

What is needed to get people to speak up more often and keep doing so, is more positive reinforcement (R+). There are strategies that help to build in more R+ for speaking up and giving feedback. The first is to make sure that the person giving the feedback focuses on giving positive feedback for desired behavior, not just correcting undesired behavior. Dowd’s article focuses on correcting doctors when they fail to wash in front of you, but she doesn’t mention what patients should do when doctors do wash their hands in front of you. I’m sure we all can think of a number of times we’ve witnessed physicians washing their hands in the examination room just before beginning the examination. That’s an opportunity to speak up and strengthen that behavior! Secondly, when giving constructive or negative feedback, plan before you do it.

By doing this you help build in positive reinforcement for the giver. A very common strategy in sales is to anticipate the objections you’ll get from customers and plan what you’ll say to overcome the objections so you move one step closer to closing the sale. In my experience coaching frontline workers, I use the same approach: anticipate the push-back a co-worker (or your doctor) will give when you speak up about their undesired behavior, plan what you’ll say to overcome their resistance and move them closer to beginning to practice the desired behavior now. Successfully overcoming resistance and getting people to demonstrate the correct behavior are usually very reinforcing to the person giving the feedback. In fact, many sales people begin to see objections as reinforcers because they represent an immediate opportunity for them to address any concerns and move the customer closer to saying yes.

Finally, it’s possible to build in more R+ for the person giving feedback by coaching the person receiving feedback on how to accept feedback well, such as thanking the person giving it and demonstrating strong listening skills by attempting the correct behavior. Apply these lessons to yourself as well.  Learning to speak up about others’ behavior may require that you look at your own at-risk behaviors, addressing the feedback you get from co-workers, reinforcing them for providing you corrective feedback, and inviting feedback in the first place. We have many opportunities in our everyday environment to speak up when we see both desired and undesired behavior. By understanding the science behind reinforcement, you can positively impact your own behavior and the behavior of those with whom you interact.


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Posted by Bart Sevin, Ph.D.

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