Trust, Self-Assessment, and Effective Communication
Trust is a necessary element for any relationship to flourish and be sustained. Excellent nurse and physician leadership teams are
- Confident in each other's abilities
- Certain that each will act responsibly
- Assured that each will set good examples while honoring the collaborative nature of the relationship
Of the possible scenarios, both leaders may already be in place. In this case, the building of trust occurs through the actions, communications, and respect shown during day-to-day decisions made by each. Alternatively, one of the leaders may require replacement. When replacing a coleader, it is imperative that the remaining director is included in the interview process to ensure the right match for the existing leader.
Choosing a coleader without considering the personality and opinions of the current leader can result in a noncollaborative leadership team. Prior to beginning the process of recruiting and interviewing a new partner, or investing the time in improving collaboration with a current partner, a period of self-reflection can be quite beneficial. Without insight into one's own personality, leadership style and tendencies, strengths and weaknesses, the qualities of the potential partner may be moot.
“Knowing others is intelligence; knowing yourself is true wisdom. Mastering others is strength, mastering yourself is true power.”
There are many tools available on the Internet to help individuals discern their leadership tendencies, strengths, and weaknesses.3-5 With this information, a committed leader can formulate ideas about his or her personal background and what might have led to the development of specific leadership tendencies. If a pattern of repetitive and negative behaviors emerges, a personal action plan may be necessary to help a leader manage the specific behaviors and the responses to triggers. Specifically understanding and addressing traits that are not team oriented may help an individual to develop collaborative characteristics. Insight into one's own leadership tendencies will help an existing leader seek and be open to those of his or her partner.
Being self-aware is only part of the equation. Leaders must be able to convey their values and attitudes and to work in partnership through open and honest communication. Not all attempts at collaboration and attempting to develop trust will be successful. There is no guarantee, even with the best of intentions, that the coleaders will achieve synergy.
In addition to understanding one's own strengths and weaknesses, it is also critical to understand the talents, traits, behaviors, and preferences of a coleader. For example, an engaging speaker may delight in giving presentations but dislike the work involved to compile the discrete details to formulate the presentation. An ideal counterpart would be a partner who prefers the behind-the-scene support work—data collection, creating graphs, and PowerPoint presentations—but despises public presentations. Identifying each other's traits, strengths, and weaknesses leads many opportunities to synchronize approach and maximize efforts/success.
Physicians and nurses may think differently in part because of their diverse training and job descriptions. By the nature of their professions, nurses are task, monitoring, and assessment oriented, whereas physicians, while also task oriented, tend to be highly concerned about achieving an overall goal in a timely fashion. Interestingly, effective charge nurses (flow coordinators) show both behaviors. Each leader brings a different perspective to the table that inevitably leads to more nuanced, complete, and well thought-out programs and processes. Shared work can lead to shared credit and opportunities to build trust.
Values are the broad and overarching umbrella driving all decisions and actions. Values are evident in work and in partnerships. For example, if one leader places high value on treating everyone equally while the other believes in a hierarchical system, discord may quickly become evident and it may disrupt the leadership team's approach to the most basic communications and actions.
Values form the basis of leadership styles. Aligned values simplify coleadership. However, absolute congruity is neither possible nor desirable. A conversation about approaches to people and processes that includes addressing difficulties and pushback can lead to a fuller understanding of the basic values of each person and inevitably a better working relationship. It is particularly imperative that the directors determine how they will achieve alignment if divergent values are discovered. Attention, in advance, to this parameter will avoid confusion and frustration among those being led. Lack of attention will result in frustration between the team leaders as well as disgruntled and ineffective employees.
Attitudes are the outward manifestation of values. A leader who values respect of all patients, regardless of whether or not the patient is “desirable,” is more likely to be cheerful, positive, and able to motivate his or her subordinates. Such a director is also more likely to be interested and skilled in collaboration with his or her counterpart. Attitudes are often evident in body language.
Communication, Body Language, and Emotional Intelligence
Everyone has a propensity for a specific communication style. Recognizing personal styles, triggers, responses are essential to positive interpersonal negotiations. (There are several self-assessment tools, such as the Thomas-Kilmann Conflict Mode Instrument,6 that are readily available to learn one's own communication/negotiation style and easily recognize the style of others.) Knowing each other's triggers is useful when situations develop that are volatile or have the propensity to become antagonistic. For instance, if one leader tends to have a fiery response to challenges from staff or from the other leader, it can be comforting to rely on a fellow director to express the unified opinion in a composed way that will be better heard. It takes practice, discipline, and a trusting relationship to avoid unnecessarily inserting an opinion or statement that will lead to rancor and loss of message. Conversely, it is unnecessary to simply repeat what the coleader already has clearly stated simply to convey the appearance of a cohesive front.
Striving for an assertive style that demonstrates respect for others is optimal. Assertive communicators are clear in their intent, and there is little opportunity for confusion. Such a style yields positive results when used not just in the ED, but also in conversations and negotiations throughout the healthcare organization.
Other communication styles are less likely to produce successful communications and resolutions. Passive communicators allow others to direct the conversation making it difficult to achieve clarity and advocacy. Aggressive communicators ironically often think of themselves simply as assertive and efficient communicators, yet there are essential differences. Aggressive communicators use body language and (lack of) etiquette to dominate the conversation, usually in a way that makes it difficult for others to communicate their position. This style leads to long-term adversarial relationships. Passive-aggressive communicators are generally frustrated and clearly transmit their intended message to others—“I'm not interested in what you have to say” and “I don't intend to work with you.” The likelihood of a win-win result is virtually nonexistent.
The majority of communication is nonverbal and volumes are spoken without a single word. This element of communication is the most difficult to change, since body language is a largely based on a set of subconscious behaviors. It is therefore commonly visible only to those who are observing and frequently, without any awareness by the speaker.
Common examples of negative body language include the habits of7
- Eye rolling: Communicates disdain, contempt, or incredulity.
- Looking past someone when speaking with them: Communicates impatience and a lack of desire to engage directly. It further limits the opportunity to obtain visual cues that may be helpful in making the communication more effective.
- Crossing arms across the chest when “listening”: Communicates disinterest, nonlistening, defensiveness, or even hostility.
- Overly dramatic negative facial expressions: Communicates rejection of ideas.
- Frequently checking the time: Communicate boredom.
- Stroking the chin: Communicates a decision-making process and may imply, “I'm judging you.”
- Faking a smile: Communicates fraudulent behavior. Genuine smiles involve the whole face and wrinkle the corners of the eyes. Fake smiles only involve the mouth and lips.
Effective open-minded leaders are willing or even eager to have these negative body language activities pointed out and to take action to eliminate them. The effort to improve is a commitment to personal growth that advances communication. Specifically, making the effort to make eye contact demonstrates acknowledgment, conveys interest, and, importantly, improves communication. Eye contact by the speaker allows that speaker to gauge whether what is being said is understood by observing the facial expressions of the listener. Openness to constructive analysis of body language is an important step to achieve a positive relationship between coleaders.
Emotional intelligence (EI) allows individuals to perceive and address emotion in themselves and others.8-10 Those with high EI can harness emotions to achieve desired results by understanding the emotions involved in communication. The ability to be aware of one's own emotions and to regulate those emotions to either enhance or suppress the feeling component of communication is a valuable skill. EI may be thought of as a social awareness that guides interactions, ie, when to speak, listen, expand a conversation, or close it. Communicators with high EI tend to exhibit positive body language, continue to develop and hone their skills, and are able to demonstrate adaptation as the interaction unfolds. They can emotionally step out of the scenario and perceive what they are communicating from the perspective of the other.
Communication coaches can help develop all of these important skills. Trusting partners can rely on each other to develop a system of signals when the interaction requires adaptation—a different approach.
Creating Safety in the Relationship
Partner trust is imperative to achieving desired outcomes. Agreeing to “always assume good intent” of the other is a basic tenet of a trusting relationship. Since the discussions between coleaders often delve into nuanced and sometimes uncertain areas of planning, human resources, operational changes, complaint management, corrective actions, and so on, it is essential that both feel safe and can have a nonjudgmental or “neutral zone” when communicating privately. Adhering to these principles allows the relationship its best opportunity to flourish and grow. Each partner will develop an assurance that the other will protect the integrity of the relationship by dealing with conflict or differences within the relationship first. If at any time this agreement is violated, the power and absolute necessity of an apology cannot be minimized if trust and an effective partnership are to be regained.