Ophthalmology Business

JUL 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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Advisable, empathic responses to employees acting problematically* "Perhaps you don't realize this but …" "I could be wrong here" or "Tell me if I'm getting this right" "Can I tell you what I'm seeing and get your perspective?" "It seems to me that the way you do X is different from what is expected. My understanding is … . Is that yours?" • "What do you think can be done about this?" • • • • When the other acts defensively or angrily, you might say: • "I'm sorry this is upsetting. Can we work this out more calmly together?" • "I'm disappointed that this discussion didn't go as well as I had hoped. I will have to think more about it. Please contact me soon if you would like to continue talking about this." • "I hear you." • "This must be difficult for you to hear." *These strategies are taken from the work of Kent Neff, MD, and from the Vital Smarts essays on "Dialogue Heals" and "Silence Kills." Readers are strongly encouraged to study these materials, as they can be useful in managing difficult conversations. begin these kinds of conversations in the sidebar. Also, consider this: Leadership is utterly crucial in developing and modeling the kinds of attitudes and behaviors that create a safe environment for employees to speak up. Importantly, everyone in leadership must be committed to a safe and nonretaliatory policy for personnel who, with good intentions, call attention to system weaknesses or problem behaviors. Remember that systems never run optimally and that personnel will always be deviating from rules and standards. The administrative response to these occasional frustrations should always be a constructive and respectful one, not necessarily a punitive one, as penalizing responses should be reserved for repeated or reckless violations of rules, policies, or standards. Consider rewarding employees who speak up and devoting resources to training employees about the need for rule following; the conse- quences of overlooking substandard performance; and how to manage situations wherein an employee observes another's questionable behavior or practices. Leadership should always provide feedback to an employee who has called attention to problematic events or behaviors and tell him or her what has been done. Oftentimes, leadership is responsive to complaints or incident reports, but the employee making the report is never informed of any subsequent constructive actions and comes to believe that nothing came out of his or her effort. All employees, unless they work in solitude, should have some ability to approach another employee and offer constructive criticism, yet there is often very little organizational training to that effect. Unfortunately, many personnel wait too long to say anything so that when they finally do, they are so upset by the severity of the situation that they can come across as shrill or even hysterical. The best advice to employees—actually in conducting any kind of emotionally challenging conversation—is to remain calm, be well rehearsed and respectful, let the other person rant and rave if he or she must, and try hard not to get angry back but, instead, try to get the other's point of view. Of course, any employee confronting another or reporting another's problematic behavior should be reasonably certain of his or her observations. Oftentimes, the employee whose work is being criticized will become defensive, so good evidence for any kind of report that negatively implicates another's behavior is a must. Notice how the conversation suggestions in the sidebar are respectful and seek the other's point of view, making it more difficult for him or her to get angry or hostile. Leadership must understand how difficult it is for (up to 85% of) personnel to confront other employees who are behaving poorly. The challenge for leadership—and there is no substitute for it—is to understand that these problems will always be present, to protect employees who do speak up (assuming their motivations are just and their observations are credible), to respond to allegations, and to insist on a work atmosphere of dignity and respect for everyone. Accomplishing and sustaining this isn't always easy, but it's always worth doing. OB Dr. Banja is a medical ethicist at Emory University and the public member of the ASCRS Governing Board. Readers are invited to send comments or cases to him at jbanja@emory.edu. July 2013 • Ophthalmology Business 21

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