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The Immutable Laws of

High Impact Communication

2013

Clear

Compelling

Memorable

Nobody want

complaints

Everyone gets complaints

It takes a lot

To correct a little

Warning

Counter-intuitive

Unnatural

The Real Title

The Immutable Laws of High

Impact Communication

2013

Coping With People

You Can’t Stand

Goals for Successful

Communication

1. Skill of Connecting

2. Value of Clear Intent

3. Self Control

4. Reframing

5. What to do when you’re losing it

6. The value of acting “a little dumb”

The Facts

The ED Can Be Tough

Communication: 3 Steps

1. Connecting (rapport)

2. Self control

3. Reframing and action

2013: 7,9,11

1. Connecting 2. Self control

3. Reframing

Communication

To Communicate

You can connect

(in seconds)

Connecting – 2 steps

Step1:

• Make a good first impression (10-25 sec)

• Reveal your intent (30 seconds max)

Step 2:

• Empathetic listening (1-2 minutes)

First Impressions

First impressions answer 3 questions:

1. Can I trust you?

2. Are you committed?

3. Do you care about me?

Lou Holtz

First Impressions

First impressions answer 3 questions:

1. Can I trust you?

2. Are you committed?

3. Do you care about me?

Lou Holtz

First Impressions

1.Can I trust you?

2.Are you committed?

3.Do you care about me?

Can I trust you?

• Promotes communication

• Reduces resistance

• Defensiveness

• Efficient

Trust

Heard

Influence

First Impressions – Visual

• Set the tone

• Primitive

• Powerful

• Visual

First Impressions

• How you look (55%)

• Your tone (38%)

• Then, what you say (7%)

Albert Mehrabian (UCLA)-

research dating to 1970

How you look (55%)

Your tone (38%)

Then, what you say (7%)

How you look (Visual 55%)

• Eyes (3-5 seconds)

• Smile (say 3)

• The hand shake or equivalent

• Posture

Not What

But How

? Consistent ?

Not Consistent → Not Trusted

Not persuasive

How you sound (Tone 38%)

• Lower is better

• Lower speed

• Lower volume

• Correcting your voice quickly

• Breathe sloooooowly

• Posture

Vocal 38%

It’s not what say

It’s how you say it

To Connect Content (7%)

• Hello, good morning, good to see you

• State your name – why

• Tell them what you do

• Their names – why

• “Please”

• “Thank you”

To Connect (Content 7%)

• State your intent

• Clear intent less resistance

• Be explicit

• Be obvious (transparency)

Empathy → Connection

Why?

Understand → understood

How ?

Empathetic Listening – A Process

1. Echo

2. Paraphrase

3. Identify the feeling

4. Validate the feeling

5. (Rare step: acting a bit dumb)

Echo (you heard it)

• “I have been here nine hours”

• Answer

• “You have been here nine hours”

• Gentle tone, concerned expression

Paraphrase (you got it)

• “ That nasty b…. yelled at me at the end of

my 12 hour shift and took my pen and

chair”

• Response

• “It sounds as if you were treated in an

inconsiderate manner”

• “Yea exactly, that’s what I’m saying.”

Identify The Feeling (you got the

emotional message)

• “They can’t do my ultrasound … are you

kidding … it’s been 3 hours”

• Response

• “You have every right to be angry”

• “ I’m not upset … I’m angry”

• “You’re angry … I can see why you feel

that way”

Validate The Feeling

• “You bet I’m upset …. I’m really mad.”

(very close to tears)

• Answer

• “I can see why you feel that way”

Validate The Feeling

• “I can see why you feel that way”

• “I can see why you feel that way”

• “I can see why you feel that way”

Counter-intuitive

Unnatural

Decent and fair

Very Effective

Empathetic Listening

• Helpful 80% of the time

• Echo, paraphrase, feeling, validate

• May require repetition

• If really bad?

• If verbally attacked?

act a little dumb

How To Act A Little Dumb

“Don’t give me that empathetic crap, that

non-verbal b.s.-- I took that same crappy

course you did -- you don’t give a damn

(or s..t)”

• Answer pause 3+ seconds

• “Pardon?”

• “I don’t know what you mean”

• “Help me understand what you mean”

Communication

1. Connecting

2.Self control 3. Redirecting

Self Control

Discipline doesn’t work!

Life-saving

techniques do

Self management:

→ competence

→ heroism

Decompensation:

→ negative interaction cycle

→ disaster

Life-saving techniques

do work posture, breathing, voice control

self talk, incantations

the pain scale

There is justice in the world

Self Control Physiology

• Breath slowly, shoulders up

• Talk more quietly than usual

• Self talk chanting and incantations

• “I’m alive, I’m alert, I feel good” 20 X’s

• “If it is to be, it is up to me” 20 X’s

• “People need love the most when they deserve it the least”

• 3, 3, 3

Self Control Use Self Talk

• This person is a “fool” - OK

• I have handled this before

• An interesting test (for me)

• Very interesting – 3rd person

• I am a movie star

• “What would Himmel do?”

Life-saving technique

for total disaster: total silence

calm expression

eye contact

listen

take a break

Accept your feelings:

Context

Self Control - Use the Pain Scale

Review your PAIN scale (1-100): context

1: an URTI

10: bad migraine and diarrhea (30 bm’s in 4 hrs)

30: broken ankle

50: complaint to College + diarrhoea (30 bm’s)

70: got fired or divorced

90: got fired + divorced, lost job, broke, and

diarrhoea

99: death of loved one

If Seriously Threatened

• Get help

• Get a colleague

• Get security

• (sociopaths, narcissists, drugged people,

totally out of control)

Communication

1.Connected

2.Self control

3. Now →reframe

Reframe to Cope and

Communicate

• Not: winner, loser

• Not: malicious obedience

• Reframing changing the game

Reframe the Game

• Patient refuses to stay for EKG

• Parent give you guilt

• Getting your child to eat dinner

• Tardiness

• Holiday call schedule

• Consultant refuses to come

• Uncooperative physician

Reframe → Goal

1. Ask questions

2. Create options

3. Get a plan

4. Get some agreement

Reframe To Persuade

• Use their name

• “What is your goal”

• “What is your major concern?”

• “What’s most important to you?”

• “How will that help”

• “Why not …

• “What if …

How to Reframe

• “What I think you are saying is …”

• “Please correct me if I am wrong. What ..”

• “What would you suggest?”

• “What is your advice to me?”

• “What would you do in my shoes?”

• “Where do you want this to go”

• “I need you to …”

Dodging Bullets

Reframe a Personal Attack

• “Your are not very competent, are you?”

• “Don’t you get it”

• Reframe (Dumb + brilliant)

1.“I can see this is important to you”

2.“You must have a good reason for feeling

so strongly”

Reframe to Persuade

Label and state positive expectation

“I know there is still good in you.

There’s good in you, I can sense it”

The Last Step:

Take

an

action

Take An Action

• Make an offer

• ED:

• Let me see when the next bed is available

• Let’s try

• Check the computer

• Get a sling or ice pack

• “May I make a suggestion?

• Thank

Summary

You under attack

1. Get emotional control

(preparation, self-talk)

2. Help people get control

(first impressions, empathetic listening)

3. Reframe with questions and actions

4. We have to help each other

FROG

SCORPION

Trust Is Not Just Technique

• Trust in 30 seconds first impressions

• Trust that lasts integrity consistency your name

who you are

Reframing

• Autonomy

• Appreciation

• Affiliation

• Respects status

Coping?

The ED Challenge

• On stage

• 24/7

• No down time

• Multi-tasking

• 1000s of lines

• Public speaker

• Performer

• Negotiator

Proof?

Here’s The Proof

• Step,

• Gesture

• Word

• Audience

• Your audience

• … you

You

are

under attack

To Be Happy

Master The Skill of

Communication