Whether we like the way the November election turned out or not, we can learn a lot from the past year's political campaign. Candidates talked about bringing people together, but their words created division and barriers. We heard harsh words, criticism, accusations, and blaming. The themes were divisive and defensive, attempting to get voters to take sides and even condemn others.
Unfortunately, this often happens outside of politics as well. Passion for a cause and efforts for change can lead to division and conflict rather than the desired change. We need to understand how to create change and channel our passion in ways that bring people together, not separate them.
Spurred by my own passion, I have made many efforts to create change in healthcare. In the process, I have often alienated people and created division myself. In our professional, personal, and family lives, the process we use to communicate can be more powerful than the cause or the issue. Working together is not just about what we say but how we say it and how we respond to others.
As NPs, we may hear criticism about our profession. Our tendency is to respond defensively. My patients tell me what their spouses, children, or coworkers are doing that makes their lives miserable, and trying to talk about it with them only leads to more conflict. Working together is a choice we each can make, whatever the circumstances, to try to make things better. This does not mean we have to accept all that is. We can choose to change the process, how we say things, and how we respond to others.
Thinking fast and slow
To understand interactions better, it helps to understand how our minds work. Psychologist Daniel Kahneman, one of the founders of the field of behavioral economics, describes two ways our brain responds. "System one" is a fast, automatic, emotional system that responds without our conscious thought. It responds without fully processing the input. "System two" is a slower, deliberate, rational, and logical system that processes things in a slower, more thoughtful way.1
When we respond with system one (our fast, or automatic and emotional, system), there is little logic in the choice of words we use and responses are based on past input and experiences. System one speaks with our emotions. Responding to system one with an appeal to logic and reason will have little effect, as the system one statement was automatic and may have little to do with reasoning.
This automatic response is helpful when a danger or threat exists and taking time to think and process might cost us our life. It also occurs when our ego is threatened, such as when we are attacked, blamed, or criticized. Our ego wants to feel good and avoid pain. Defending and attacking seem to help us feel better when criticized, but we do not really feel better-at least not for long. Our defensive response stifles our creativity, compassion, and understanding. It closes and narrows our perspective so we have little opportunity to see the bigger picture. It may expose us to more threats, attacks, and criticism as the conversation and emotions escalate.
Criticism and pointing out fault often lead to the dysfunctional dialogue of system one. When someone tells us we did something wrong or that he or she does not like what we said, we want to explain what happened, blame someone or something, or tell that person what he or she does wrong. Your partner complains that you leave your socks on the floor, and you respond that he or she leaves the dishes in the sink. These are two unrelated issues; there is no logic connecting them but just a fast and automatic response. This kind of dialogue creates conflict.
To work together, we need to consider how we present our views and how we respond to the comments and criticism of others. When we know or think we are right, we often want to make our point or point out a fault in another. This only engages a defensive response, as it "traps" the listener without an easy or graceful way out of the situation. Anything that criticizes or puts the other on high alert is likely to result in a system one, automatic, defensive response that has a lot of emotions and little rational thinking or logic behind it. Though we may be right, if our statement puts the other person on high alert and strong emotions are triggered, defenses and conflict result rather than dialogue or solutions.
Seeing from the perspective of others
A more effective way to bring up an issue is to present it in a way that engages the listener. It is a gentler and slower approach that gets to the point but leaves the listener without strong emotions and a need to protect and defend. Rather than stating something to prove your point, put yourself in the place of the listener and think about how you might respond to your own words.
Would your system one take over if you were that person? Consider using milder, less absolute words, leaving your listener a graceful way to respond. Try changing a directive statement to a question, soliciting input, and giving the listener a feeling of participation in the process. This strategy helps everyone to see things from a broader perspective. It does not happen when system one is active. As we diffuse the defensive response, an opportunity opens up for creativity, discovery, and a search for solutions.
When attempting to create change, keep your focus on your goal. Proving your point, that fact that you are right, may stifle conversation or create conflict without creating the change you were seeking. Look for common ground when an issue is controversial and begin dialogue with that. Though there may be substantial differences, first exploring what you hold in common can lead to a more productive start with less conflict and more cooperation.
Another strategy is to acknowledge something your counterpart has done or accomplished before sharing your point. This helps to build a connection, a mutual understanding, and can be a pathway to dialogue and creative problem solving. To work well together, we must also be aware of how we respond to others. Consider the following example:
We often hear physicians state that NPs do not have enough training and education to practice safely. This may push our buttons and get our emotions going. Our tendency is to defend, rationalize, justify, blame, and compare. This is our system one responding and will usually lead to a system one response back from the physician. Logic does not work when system one is engaged. No statistics or proof will overcome system one.
A more effective way of responding is to try to put ourselves in the position of the other person. In this case, what might a physician be feeling about NPs when making this statement? Certainly we have our own emotions, but what might be the emotions (not the logic) of the person making the statement? Fear, resentment, or anger may be playing a part. When we can hear the emotion (not just the words but the "why" behind them), we can respond, not so much to the words, but to the emotion.
Sometimes recognizing or stating the emotion the other may be feeling will help the person feel heard. Acknowledging the number of hours of training a physician has and the hard work that physician has done can soften the edge and leave an opening for dialogue. While it is not necessary to agree with the other person's statement or logic, acknowledging lets him or her know we hear and are listening, which can lead to creative, solution-oriented conversation.
Dealing with our own emotions
This type of communication takes practice. It does not come naturally for most people. Our system one wants to automatically respond and defend. It can be helpful to be aware of things that trigger your emotions and lead to defensive responses. This awareness can help to counter system one. When you sense those triggers, take a few deep breaths before responding or take a "time out" to distance yourself a little before speaking. Creating a pause and some distance can help engage system two and broaden your perspective.
Even if we do not always recognize the triggers, a helpful practice is to work on eliminating any responses that justify, rationalize, defend, blame, or compare. These five responses are usually from system one and are distractions from the real issue. They may be useful in a court of law but do not help build relationships or dialogue. Eliminating them is a simple way to dramatically change interactions and facilitate discovery and solutions.
Healthcare is about relationships and communication. We need to build relationships and work together. It is easy to focus on curing disease, creating change, or solving problems and miss out on the process and the relationship.
Listening, acknowledging, hearing perspectives, and building relationships are tools to help treat patients and work together in more constructive and healing ways. Building relationships is the "care" in healthcare. By learning to eliminate the defensive responses and trying to hear and understand the perspectives of others, we can grow in relationships. The way we work together, relate to each other, and the way we care affect the health of our society. It is time to come together, work together, and make things better!
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