Messy moments: Handling hostility

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During an end of shift multi-disciplinary huddle, you propose trying a different approach to a routine process that has gone wrong recently.

Bill, an MD in the practice, walks by and says combatively: “I’m so tired of this – making changes without any good reason. You cause havoc. We’ve done it this way for a long time, and it works fine. Someone messed up here. Just get your providers to do it right.”

What’s happening here?

• Norm focuses on the negative and blame. He likes the attention of interrupting. His words also seem intended to embarrass you and the clinician who may have triggered the problem.
• His hostile communication style will upset everyone.
• Who is the most vulnerable person here? The person Norm implies is at fault. That’s your most important audience. However, everyone will notice how you deal with Norm’s blaming and disruption.
• Your heart rate has sped up. You don’t know what to do. His interruption hijacks the meeting. You need a quick wrap-up of agreed purpose and next steps.

What do you want to happen?

• Everyone believes that respect, a kind tone and appropriate words and timing are expected and necessary for the practice to continue to deliver quality care together. It’s critical that they know hostile behaviors are unacceptable. They threaten and silence people. They’re also contagious!
• Model desired behavior so everyone sees what is expected in communication and collaboration
• Support the person Bill blames: they are vulnerable. Return to discussing the system that caused the problem and creating an improvement together

Prepare yourself

• Pause: Take a slow deep breath. As it moves through you, notice tightness in your body, notice your heartbeat, notice your feet on the floor.
• Label how you feel. You may feel threatened by Bill. Labeling moves the emotions away from you so they can’t hijack your next words and actions. Don't banish them! Let them walk beside you: that gives you the space to think.
• Decide your intentions. Calmness gives you space to respond more wisely. How do you want to show up for your practice? What do you hope to accomplish in your relationship with Norm? What do you want for your care group/practice?

Attend to your care group and the work at hand:

1. Buy yourself a little time. Create a phrase – a brief phrase! - ready for moments like this. It enables everyone to pause and lowers the moment’s temperature. For example,

• Clarify what is happening“Thanks, Bill. That’s something we can consider.” Ask the group: “What do you think about leaving things as they are?”
• Get curious. Bill might offer useful information: “Thanks, Bill. What happened for you the last time you used this process?”
• Invite everyone back into the conversation about what happens next: “Thanks, Bill. [Turn back to group] Now let’s hear from everyone else. What else can we do to make this work better?”

2. Re-engage people in your purpose – to find ideas that can improve clinician’s experience and patient care.

• “Let’s hear from everyone else: What would help you do your tasks better – and maybe easier - in this situation?” Make sure that you turn to the person Bill blamed to show your support: “What matters most to you in these situations, Jim?”
  • Open-ended questions invite people into the discussion so they feel included.
  • Restore their safe zone. Re-assure people by looking at each one. Use their name. Invite them back in by asking what they think. Appreciate their ideas.
  • Questions focus you on listening rather than talking or leaping to a solution.

3. Circle back to Bill later privately. The moment asks you to build a relationship with a future.

1. Appreciate Value him and his long experience in the practice: “You’ve handled this many times in your work here.”
2. Acknowledge discomfort and emotionsAcknowledge his discomfort with more changes. “It’s understandable that you dislike the idea of making more changes. It’s so confusing now with changes in rules and conditions! Bill - I’d like to know how you’re doing with it all. What’s happening for you here these days?” Then listen.
3. State expectations
   1. “Our practice has gotten much more complicated and stressful. I need them to tell me about my patients, because I just can’t know everything that is important. So I need to make sure our people feel safe enough to speak up. I really want them to want to work here!”
   2. “We can only get their candor and their caring by speaking respectfully and listening to them. Everyone needs to feel they have a voice in the practice, and they’ll be respected whatever they offer. This is important for all communications with our staff and colleagues.”
   3. “Lots of our former processes just don't work well now – things are more complicated. We need to change how we work so jobs are doable. Most staff are stressed and overwhelmed now. We need their help shaping changes. Our job is to listen to them and figure out together how to make it better for them and for our patients.
4. Invite him in “We considered your wish to leave things alone. A few people really want the process to work better. Do you want to know what we’re going to try? It might be useful for you during X procedures. I think you’ll have ideas about how to make it work.”

What does this do for you?

• Reduce your discomfort from contentious situations
• Get more and better information on patients and processes because people are less fearful. They trust that psychological safety is a priority and disrespect is not acceptable, even by those with higher rank
• Reduce the uncertainty you face daily and find better solutions to daily challenges by tapping all the experience and angles from your care group. They know that decisions depend on their participation and ideas. They know they are needed. They tell you more and more quickly
• Improve the climate and everyone’s effectiveness by modeling coping mechanisms that foster fruitful relationships
• Reduce others’ discomfort from contentious situations, too! We all feel distress and difficult feelings when we watch hostile behavior and toxic relationships - even if we’re not involved. These emotions impair our thinking and actions. Disrespectful behaviors also spread discontent. People feel unsafe. They withdraw and don’t speak up. The work and patient outcomes suffer. Clarify you’ll champion respect to cultivate kindness in working together generate

Your immediate response to the hostility proves very important. Everyone faces difficult people everywhere in this stressful work. Meetings offer a powerful crucible for learning. You broadcast that the work expects respect and safety for everyone at work.

Don’t delay by searching for the perfect words. Have a go-to sentence ready to follow a few slow breaths.