Crucial Accountability

5/19/2018 Crucial Accountability

1/10

Crucial Accountabilitye er a son,

Northwest Perinatal Center

Womens Healthcare Associates

Portland, OR

CrucialAccountability: Disclosure

I have numerous interesting conflicts andwill talk about almost all of them at any

o ortunit . I dont a rove of dru s,

products, or devices and can guarantee

they wont come up in conversation today

or any day

Peter T Watson, MD

CrucialAccountability

Patterson K et al, Crucial Accountability:

Tools for Resolving Violated Expectations,

ro en omm tments an a e av or,

2nd Edition, 2013; New York, McGraw-Hill.

Crucial Accountability: Definition

A subset of crucial conversations (i.e.,

when opinions vary, emotions run strong,

and stakes are high.)

Crucial accountability = disappointments

(i.e., violated expectations, broken

commitments, bad behavior.)

Crucial Accountability

Conversations: The most importantpersonal characteristic for making

change happen is:

accountability conversations and an ability

to make them successful; i.e., to solve

problems and to build relationships.

Patterson, K et al. Crucial Accountability, 2013.

Crucial Conversations

High

Stakes

Strong

Emotions

Conversation

Differing Opinions


2/10

CrucialAccountability

Violated Expectations

Broken Commitments

Bad Behavior

Crucial Accountability: Examples

Daughter on first date agrees to curfew,

comes home two hours late. Beloved boss agrees to protocols then

.

Co-pilot sees ice on wings, notifies pilot

who checked them. Pilot ignores him.

Shuttle engineer discovers O-ring failure,

fails to notify responsible superiors.


Conversations: Choices

Avoid them

Face them and perform poorly

Face them and perform well

Crucial Accountability: Fools Choice

Speak up and make an enemy or

Stay silent and continue to suffer

while a problem goes unsolved.

Crucial Accountability: Fundamental

Consequence

, .


Crucial Accountability:

Fundamental Observations

You are not only responsible for what you

say, but also for what you dont say.

Martin Luther

I always wondered why somebody didnt

do something about that, then I realized I

was somebody.

Lily Tomlin


3/10

Crucial Accountability: Ifand

What

Before you embark on an accountability

discussion:

Decide ifyou should have the

conversation in the first place.

And if so, what kind of conversation

should you have?

Crucial Accountability Conversations:

When not to have them (without help.)

Personal danger: Leave, call for help, notify HR Illegality: Call HR, legal counsel, senior partner,

practice manager

Adverse peer pressure: Discuss with HR,

influential peers, mentors.

Significant uncertainty: Discuss with HR,

mentors.

Crucial Accountability: Questions (ifyouve

decided to have the conversation.)

How can I be effective when Im so

nervous?

Can I be 100% honest and yet 100%

respectful?

Is this skill innate or can it be learned?

What are the steps involved?

Crucial Accountability: Getting Started

You need to hold a Crucial Accountability

Conversation but youre stuck. Whats

the issue and what sort of issue is it?

Unbundle it with CPR

Content

Pattern

Relationship

Crucial Accountability: CPR

Unbundle it with CPR

Content:A specific event or issuePattern:A set of ongoing events or issues

Relationship: A set of interactions between

two or more individuals affecting results

Crucial Accountability: Start withHeart (Most Important Question)

What do you really want:

or you

For others?

For the relationship?


4/10


Start with Heart (Questions) What are you acting like you really want?

What do you really want?

How would you behave if you really

wante t s

What do you not want?

How should you go about getting what you

want and avoiding what you dont want?


Conversation Goals Make it clear: Describe the gap between

what was expected and what happened. Make it dialogue: the free flow of meaning

.

Make it safe for all parties.

Make it effective: Diagnose sources of

influence.

Make it last: Establish follow-up.

Crucial Accountability: Overview

Before:

During:

Work On Me First

Get Unstuck

Start with Heart

Master My Story

Silence

Safety

After: ViolenceSafety

POOL OF

SHARED

MEANINGState My Path

Make it Safe

Explore Others

Path

Move To Action

Who Does What By When; Follow-up

Diagnose Sources of Influence

Crucial Accountability: Key Steps

Start with heart: Focus on goals.

Master your story: Regardless of anger or fear.

State your path: Persuasion without abrasion.

Learn to look: Notice when safety is at risk.

Make it safe: Regardless of content. Clarify intent.

Explore others paths: Despite silence or violence.

Diagnose: Discuss the six sources of influence.

Move to action: Turn dialogue into results.

Crucial Accountability: Master

your Stories (Path to Action)

HEAR

STORYFEEL ACT


your Stories (Path to Action)

See and Hear: A factual event or events.

Tell a Stor : How ou inter ret the event s .

Feel: How you feel about your interpretation.

Act: How you act on your feelings.


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your Stories (Skills)

Retrace your path to action. Separate fact from story.

Watch for three clever stories:

villain, victim, or helpless stories.

Tell the rest of the story.

Crucial Accountability: Masteryour Stories (Three CleverStories)

Victim stories: Its not my fault. My motives

are pure. Villain stories: Its his or her fault. Their

.

Helpless stories: Theres nothing I can do.

Its his or her fault. I have only the Fools

Choice, stay silent and suffer, or speak out

and ruin the relationship, be punished, etc.


your Stories (Sellouts) Clever stories lead to sellouts

Sellouts: conscious actions against your

own best interest:

ou e eve you s ou apo og ze, u on .

You see a problem and dont speak up.

Tell yourself useful stories instead, theyre

closer to accurate, complete, the rest of

the story.

Crucial Accountability: Useful

Stories

What is my story? Is it a useful story?

What am I pretending not to know about my

Why would a reasonable, rational, decent

other person do this? (Imagine the best of

others, start with benefit of the doubt.)

What should I do right now to move toward

what I really want?

Crucial Accountability: You have a

Tough Message; To Be Honest and

Maintain Safety: State your Path

Share your facts re the gap

Ask for others paths

Talk tentatively

Encourage testing

(Always end with a question)

Crucial Accountability: You have a Tough

Message; To Be Honest and Maintain Safety:

State your Path

Share your facts re the gap

I noticed Twice you

Tell your story

It seems to me; I wonder if

Ask for others paths

How do you see it?; Help me understand

Talk tentatively

Avoid absolutes. Own your story.

Encourage testing (Always end with a question)

Do you see it differently? What am I missing?


6/10

Crucial Accountability: State

your Path ( Key Questions)

Am I really open to others views?

Am I talking about the most important issue?

Am I confidently expressing my own views?


Before:

During:

Work On Me First

Get Unstuck

Start with Heart

Master My Story

Silence

Safety


POOL OF

SHARED


Make it Safe

Explore Others

Path

Move To Action



Crucial Accountability: Learn to Look for

Safety (or Lack of It)

Look for when the conversation becomes

critical (i.e., hostile, tense, one-sided.)

Look for safety problems.

Look for signs of stress.

Crucial Accountability: Learn to

Look for Lack of Safety

Am I withdrawing or attacking (silence or

Are others either withdrawing or attacking?

Crucial Accountability: Make it

Safe

People get defensive when they feel unsafe.

People rarely get defensive about what it is

.

If people are defensive, its usually about

why they think youre saying it (Intent.)


Safe

Clarify intent by building mutual purpose

and mutual respect.

your goals and vice versa.

Mutual Respect: You believe I care about

you as a person and vice versa.


7/10


Safe

Apol ogize Contr ast

Clear Problem Misunderstanding

Mutual

Res ect

Create Mutual

Purpose

ContrastMutualPurpose


Safe

Apologize when appropriate.

Contrast to fix misunderstandings.

Crucial Accountability: Make it Safe

(Contrasting to Fix Misunderstandings)

Start with what you dont intend or mean.

I dont think/mean/want to

(Try to avoid but in between.)

Then explain what you do intend or mean

What I do think/mean/want to is

Crucial Accountability: When Others are

Silent or Violent, Explore their Paths with

AMPP

Ask: To get things started.

Id like to hear you opinion on this.

Mirror: To confirm feelings.

, .

Paraphrase: To acknowledge their story.

Lets see if Ive got this right

Prime: If youre getting nowhere.

Let me guess, you thinking (feeling)

(Now youre ready for a discussion about

motivation and ability)


Before:

During:

Work On Me First

Get Unstuck

Start with Heart

Master My Story

Silence

Safety


POOL OF

SHARED


Make it Safe

Explore Others

Path

Move To Action




People change their behavior when

so.

Joseph Grenny, in Crucial Accountability, 2013.


8/10

Crucial Accountability: Six Sources of

Influence

Motivation Ability

Personal 1 2

Social

Structural

3

5

4

6

Make it

MotivatingMake it

Easy


Crucial Accountability: Personal Motivation

Left by yourself, would you want to?

Do you hate or enjoy it ? Do you find meaning in it ?

Sounds like

I dont like

Thats not fun for me

Thats just who I am

Crucial Accountability: Personal Ability

Left by yourself, do you have the knowledge,

skills, and physical ability to ?

Sounds like

can p ys ca y

I dont know how

I keep trying, but I cant figure it out

Crucial Accountability: Social Motivation

Are other people (including me)

encouraging the right behavior or

discouraging the wrong behavior ?

Sounds like...

The boss told me to do this

Shes been praising this for months

Everyone is doing this

Crucial Accountability: Social Ability

Do others (including me) provide or

withhold the help, information, or

resources required at critical times ? Sounds like

He didnt get me the material I needed

She didnt teach me the new system

I needed her approval, but she said no

Crucial Accountability: Structural Motivation

Are the non-human motivators (pay,

performance reviews, promotions, perks,

costs, etc.) encouraging the right behaviors or

Sounds like

That wont affect my yearly review

Thats not what I get paid to do


9/10

Crucial Accountability: Structural Ability

Does the environment (equipment,

facilities, information, policies, proximity toothers, etc.) enable good behavior or bad?

This ultrasound machine cant give me the

images I need

This policy gets in the way of good care

I struggle counseling patients with all this

noise


Influence

Limitations of Diagnosis Causes can be complicated

o va on an a y can e n e

Responses may be ambiguous

Responses may be masked

Diagnosing can sound like excusing

Crucial Accountability: Six Sources of Influence

Removing Ability Barriers, Making it Easy

Start here; ability often fixes motivation

Clarify boundaries, constraints

Ask for ideas; empowers, motivates, likely to produce

the best suggestions

Dont

Play read my mind

Leap in with a suggestion

Discourage others suggestions

Worry about having to know everything

Feel the need to solve everything


Influence

Make it Motivating

Look for self-motivation

Avoid trying to motivate with power (i.e.,

Clarify natural consequences instead ( i.e.;

make the invisible visible)

Consider all three motivational sources

(personal, social, structural)

Return to ability barriers as a final step


Influence

Motivation Ability

Personal 1 2

Social

Structural

3

5

4

6

Make it

MotivatingMake it

Easy


Crucial Accountability: Moving to Action

The way you complete an accountability conversation is

as important as how you start it; if you swap your

backbone for a wishbone, you set yourself up for a whole

new set of problems.

Jose h Grenn

Those people blessed with the most talent dont

necessarily outperform everyone else. Its the people

with follow-through who excel.

Mary Kay Ash

Action is the foundational key to all success.

Pablo Picasso


10/10

Crucial Accountability: Move to

Action (Questions)

Who will do what by when?

How will we follow up?

Check-up or check-back?

Do others need to be involved?

Lead

Manager (e.g., Practice Manager,

Managing Partner)

HR


Conversations: The most important

personal characteristic for making

change happen is:

w ngness o en er n o cruc a

accountability conversations and

an ability to make them

successful; i.e., to solve problems

and to build relationships


Conversations: Start with the heart

Focus on what you really want.

For you, others, relationship

Refuse the Fools Choice

Speak up and make an enemy

or stay silent to preserve the

relationship.

Documents

Crucial Accountability