Listening with Purpose

I’ve been an apprentice of servant leadership for several years now, having once been in the role of teaching its principles to health care leaders. In his classic essay, “The Servant as Leader,” Robert K. Greenleaf said that “only a true natural servant automatically responds to any problem by listening first.” As caregivers, we may not be able to take away all of the pain, sadness, disappointment or anger that an illness provokes, but we can listen. As a hospital services improvement manager at Press Ganey, I’ve noted just how granular a patient’s perceptions of this can be. How is it that a nurse or physician can demonstrate service excellence by “always” treating patients with courtesy and respect and explaining medications and so many other aspects of care, but struggle with the patient’s perception of “how often did doctors/nurses listen carefully to you?” I’ve decided to put my servant heart to the test on this dilemma.

First and foremost, the use of the word “carefully” is intentional. Listening should be intentional – with purpose. A case in point is the way I sometimes respond to my sons when they walk into a room while I’m busy at work. Priding myself as an above average multi-tasker, I lend only a partial ear, offering little more than an occasional nod and “uh huh” here and there, relying on my filter for hot words to alert me when more attention may be required – words such as police, flunk, insurance, etc. What would I need to do differently or more often for my child to tell his friends, “My mom always listens carefully to me.” I’m reminded of some effective communication techniques I’ve discovered through the years – all of which promote engagement in the listening process:

• Restating – repeating what you hear the person say, but in your words. “Let’s see if I’m clear – you had your purse on the chair and now it’s gone?”
• Summarizing – bringing the pieces of the conversation together to verify understanding. “It sounds like you may have trouble getting a ride home from the hospital tomorrow; is that correct?”
• Prompting – using brief, positive prompts to keep the conversation going. “Oh…and then…?”
• Reflecting – introducing your perceptions and feelings into the person’s words. “This seems really important to you.”
• Offering feedback – sharing your initial thoughts on the situation, providing pertinent information, observations, insights or experiences. “It’s not uncommon to be nervous before surgery. I’ve cared for many surgical patients. What specific things are bothering you?”
• Emotion labeling – using a descriptive word to restate a patient’s feelings may help the person see things more objectively. “You appear frustrated this morning; what can I do to help?”
• Probing – drawing the person out to explore the deeper meaning to what he is saying. “What do you think might happen if you are unable to stay on this new diet?”
• Validation – acknowledging the problem, issue or feeling while remaining open and empathetic in your responses. “I appreciate your willingness to talk about such a difficult issue.”
• Pausing – deliberately pausing at key points for emphasis. “Your medication may cause dizziness… (pause) … do not attempt to get out of the bed unassisted.”
• Silence – allowing for comfortable silences to slow down the interaction offers the person time to think as well as talk. Silence can also be very helpful in diffusing an unproductive interaction.
• “I” messages – (not to be confused with iPhone, iPad or iPod) putting the focus on the discussion, not the person, by bringing yourself into the conversation. “I would really like to talk some more, but I need to step away for a bit. Could we continue our conversation when I return to check on you in an hour?”
• Redirecting – diffusing an escalation in aggressiveness, agitation or anger by gently changing the topic of discussion. “You mentioned your granddaughter may come visit you tomorrow. That sounds wonderful.”
• Consequences – providing a “reality check” as part of the feedback loop. “What happened the last time you stopped taking the medicine your doctor prescribed?”

Self-awareness is another important tenet of servant leadership that facilitates effective listening. When I think about body language and that earlier example of communicating with my sons, it occurs to me that folded arms or a wandering gaze may be sending the wrong signal – impatience, indifference, intolerance, etc. Without realizing it, I might discourage them from speaking openly and honestly – the last thing I would want to do! Pulling out the imaginary mirror, we can get up front and personal with how others perceive us – our demeanor, mannerisms and facial giveaways – exaggerations that only a caricature artist could love. Or perhaps we’ve allowed marvels of technology like COW’s and smartphones to become the focal point during bedside interactions. Experience has provided some insights for enhancing body language and minimizing distractions from the listening process.

• Sitting down – assuming that the other person is seated or reclined, getting on the same level opens the dialogue while conveying, “I am taking time for you.”
• Eye contact – maintaining eye contact reinforces where your attention lies and conveys “I am interested in what you have to say.”
• Touch – reaching out to people with a gentle touch reinforces the human connection and conveys caring. Touching a person’s arm or shoulder lightly while validating their concerns is very powerful. “I can see that you are anxious about going home.”
• Hands-free – stopping whatever it is you are doing – if only briefly – communicates “I am giving your words, your thoughts, your feelings my full attention.”
• Smiling – a smile in an invitation, encouraging the individual to share thoughts with you while saying “I am here because I want to be.”

The Greek philosopher Epictetus, who spent a portion of his life as a slave, is credited with saying, “Nature hath given men one tongue but two ears, that we may hear from others twice as much as we speak.” I think of it this way – hearing is to listening as data is to information. Absent the ability to translate spoken words into meaningful expressions of human feelings and thoughts, the voice of our patient, customer, colleague or family member simply falls on deaf ears.