Beyond the “Language of Trust”

Creating a Culture of Decision Makers for the Ongoing Success of the Practice
Author: Peter J. Marincovich, Ph.D.

Trust and Communication — making a human connection — are essential ingredients for any successful relationship. Trust within a business environment must begin with top management and then permeate the organization. Having a well conceived plan designed to build rapport and camaraderie among staff and patients, through an organized process to improve interpersonal communication, pays dividends in terms of employee longevity as well as patient loyalty over time. While this sounds great, arriving at these conclusions and knowing how to achieve them are two different things. It was not automatic and did not come easily for me, and my Audiology Associates team.

The plan we eventually adopted resulted in measurable improvements in patient satisfaction, going from 87% to 97% within five years. It reduced staff turnover from 8% to less than 3% — and to less than 1% in the past two years. It also produced greater staff/patient connectivity, and higher patient retention rates measured by follow up records at our three locations in Santa Rosa, Mill Valley and Mendocino. These improvements did not occur overnight and required a concerted effort to learn more effective ways to interact and communicate. So, how did we get here?

Since it takes a lot of time to get to a point where you think you have built a successful “working” practice, there is a part of you that says — if it’s not broken, don’t fix it. But the inner voice of the entrepreneurial part of me lurking in the background was saying, “You can do better than this.”

I’ll never forget Hal Holbrook’s remark as he portrayed Mark Twain on stage: “It is not until you think you know it all that you really begin to learn.” John Maxwell talks about the five phases of awareness and the Law of Process for changing leadership perspectives. These phases include: I don’t know what I don’t know; I know I need to know; I know what I don’t know; I know, grow and it starts to show; and finally, I simply go because of what I know with knowledge learned making actions easier and more natural.

About eight years ago, after establishing my practice some 22 years earlier, I felt something was missing. We were doing things over and over again the same way and expecting different results. Staff turnover was high and patient satisfaction was less than desired. We were not where we needed to be as a team. I also realized that things were not going to change unless I changed and became aware of what I needed to know. In an attempt to resolve these issues, I attended leadership training workshops, read more than 30 books and listened to management CDs in my car.

Beyond the Language of Trust was chosen as the headline of this article because it builds on one of the many books I read entitled, “The Language of Trust: Selling Ideas in a World of Skeptics,” by Michael Maslansky, Scott West, Gary DeMoss and David Saylor. This book focuses on effective ways to communicate with clients, customers and patients on their terms to gain their confidence. While these recommendations are excellent, they address only half of the equation.

Our goal was to go beyond external guidelines to include internal communications as a prerequisite to building effective team and patient relationships. Our plan evolved over several years through many team meetings during which we defined our vision, mission, as well as team values — and my values — that led to a revitalized culture.

I wanted to take it to the next level and really understand what I should be doing and, in the process, help our team become more effective. This approach involves helping the team seek out new opportunities and career paths, while giving them tools they need to succeed. As a leader, I also had to know when to get out of their way and let them do the things I brought them in to do – by making them better decision makers.

Our team embraced this. They saw my passion and knew it is coming from a good place. Furthermore, they knew that in order to give back to the community they needed to grow. This led to a creative way of engaging and empowering the staff, while significantly enhancing patient satisfaction.

In the words of Dan Oswald, “Communication must be HOT – Honest, Open and Two-way.” What we say and how we are understood are often not the same. Having a vision of creating better communication is a window on the successful world of tomorrow.

Where do you begin? First, realize that good communication takes effort. You have to work at it. It starts with developing an honest, interactive communication process among team members. One reason why people don’t speak their minds is because it is often easier and less threatening to say nothing, or because they fear repercussions or possible rejection if they do.

Throughout my career, I’ve found that effective communication begins with mutual respect, transparency and communications that both inspire and encourage others to do their best. As any marriage or business consultant could tell you, many relationship problems are rooted in a communications breakdown as simple as not really hearing what the other person is saying, or because he or she did not understand what you conveyed. “Information” is something you give out, but “communication” is what you achieve by getting through and engaging the receiving party.

To embrace open communication as part of your culture, you have to talk about it, praise it, nurture it, and reward it. And, as a leader, you have to become the living embodiment of effective communication and deliberately demonstrate it every day.

As James Humes said, “The art of communication is the language of leadership. It is the responsibility of leaders to create and maintain understanding and trust between people by not only providing information, but by receiving and analyzing feedback and creating understanding.”

This process stemmed, in part, from my need to trust myself. I had to overcome fear of failure to grow and create opportunities for my team – a task I chose to meet head on. You often hear the words “fail fast” or “you need to fail to learn” and “learn from your mistakes” as well as things like “Babe Ruth struck out 1,330 times” but went on to have a highly successful career. These are more than just clichés, they contain kernels of truth.

I remember when I was learning to ski. I would come in at the end of the day happy that I never fell. It turned out that kids who were developing skills and techniques quicker than me were falling all the time. I thought to myself, how can this be possible? They were challenging themselves and then learned from their mistakes, while not being afraid of failure.

When starting out in business, I thought I had to have everything perfect. As a consequence, often my ideas did not get tested, or even evaluated. Also, if I did finally implement them, it was often too late because I had waited too long for things to be “just right.” Either someone else would have come up with the idea — or by the time I got around to implementing it — it was no longer relevant.

As I learned to become more proactive, I found that what I needed to do for myself was to have clarity of purpose and then establish systems and processes that would produce the desired outcome for the team as they helped produce in me. Setting a good example and modeling appropriate behavior is the most effective means of communication.

In developing “Beyond the Language of Trust” as a team, we all agreed to agree on one thing – that moving forward we had to be upfront and forthright with each other by establishing open and clear paths for communication. As our team developed, we focused on producing a simple visual communications organization chart.

When I say “simple” what I mean is a linear way to show paths of communication, since often charts like this can become so convoluted that they hinder the very reason why they were developed. The linear path we created did not look like an octopus with tentacles going everywhere.

Next, we developed a “system for creating systems” to foster clarity. We also learned to ask questions, ask referral sources, ask each other and equally important, we asked patients. Finally, after systems and processes were in place, I became committed to ensuring clarity by repeating, reviewing, creating stories and just talking about what was important. While repetition is reinforcing, the more elaborate the means of communication, the less we communicate. It has to be kept simple.

The first step to insuring clarity involved meeting with each team member and discussing goals as part of organizational development. We focused initially on individual staff goals – who do they see themselves as individuals and professionals, their hobbies, interests, what they need and what they like, etc.

We identified career path interests and talked about how they envision reaching their goals. The last step was integrating their personal desires and aspirations in line with financial aspects of the practice and how this viewpoint can help them achieve their objectives.

It was an exercise at this point, but by reviewing what the business has to look like in order for them to achieve their goals, and showing staff members that they have a direct influence on the business reaching those levels, it helped to put my role as leader of the team into context. These discussions added to the candor and clarity I wanted to foster at every step of the way.

The outcome was the development of metrics, benchmarks and goals for the practice as a whole. To this was added a process for discussing where we are each month. Not only did open communication add clarity, it also produced contingency conversations with options if alternatives were required to achieve objectives.

For example, today patient appointments are set up in the office with various members of the staff assisting with different aspects of the process. Job descriptions are coordinated with state requirements. We call it our 30/30/30 system. I divided many 90-minute appointments into three, 30-minute segments. During the first and last segments assistants, providers and support staff see patients and provide initial services. The middle 30-minute segment is reserved exclusively for the audiologist.

This not only frees up one hour of audiologist scheduling time, but it engages the staff and helps them expand their capabilities beyond the formal “job description.” Team members are directly involved with patients at varying levels and become a larger part of the hearing health care delivery process. At the same time, patients receive a remarkable experience at what is often referred to as a “destination” because everyone in the office knows them and can help them.

Through our exclusive MA5P METHODTM, (personalized Assessment, Active listening, Adaptation, Assistive technology solutions, Aftercare and hearing loss Prevention), we reconnect patients and dialogue with them about ways they can achieve a lifestyle that may not have been possible without these comprehensive clinical services and restore their lives through better hearing, our “why”.

In addition, we established Key Performance Indicators so we would have an ongoing system for evaluating where we are as a business and how well we are communicating with each other and our patients. Throughout this journey, I discovered that we had five different generations working together. To effectively communicate, we had to realize that we are all different in the way we perceive the world and use this understanding as a guide to communicating with others. As management consultant Peter Drucker said, “The most important thing about communication is hearing what isn’t said,” or as George Bernard Shaw was fond of saying, “The single biggest problem in communication is the illusion that it has taken place.”

I mentioned that we created a linear organization chart. For me, and half of my team, this made perfect sense — the “millennial” generation (also known as generation Y) who reached adulthood around the year 2000 did not have a problem seeing multiple paths and lines of communication. It fact, this turned out to be one of their strengths. But for other generational groups, this linear format was not as easy to comprehend or embrace as we expected it to be.

Listening is much more important than talking, because listening determines whether we learn anything and that actual communication has occurred. Consequently, I developed different communication modes for different staff members based on listening to their responses and being intentional about learning exactly who I was working with as I gleaned their perceptions of the process.

For example, some of my staff benefits from a sit-down meeting with a formal agenda to review. It’s not that everybody doesn’t profit from this approach, but for the millennials – and through osmosis — some other staff members also benefit from “water cooler” conversations and chats on the fly.

This realization led to a redesign of the office to take advantage of this “new” mindset. Our lab was previously situated in a somewhat closed-off area separated from the rest of our workspace. Now the lab is the center of the office with open access to patients, providers and other staff moving about more freely.

A significant outcome for me at this point was that — while I was striving to understand staff perceptions — what is important to them and how to communicate more effectively — this process led to a very open discussion about them learning how to communicate with me. Given that it is essential to be the initiator of such a plan, and an active listener to staff members, recipients must value the listener as well.

The second step involved having everyone complete a self-assessment identifying strengths and non-strengths. This revealed who were the drivers, influencers, and stabilizers and who liked the analytics. At the same time, weaknesses surfaced, and I learned what they feared. Some individuals like to communicate, others less so, and I learned what to do and what not to do when attempting to communicate with each person. In addition, I learned more about their behavioral characteristics, their perceived limitations and what motivated them.

This accomplished three things. It let me, and other members of the management team, know if we had the right people on the bus. It surfaced information about who had what strengths allowing us to create more balanced teams. Finally, and perhaps most importantly, it sent a message to the team that I cared, and that I cared in a meaningful, helpful, value-added, leadership way.

Third, as a collective group, we created our vision, mission, values, tenets and our credo, while also incorporating my credo for the organization into the mix. We spent a lot of time on this. The entire process took about a year and was well worth the effort. The hardest part, and probably the most significant, was in determining our values.

While it was relatively easy to come up with core values, we wanted to do more. We defined the values we wanted to create as “aspirational” values, such as “to tell the truth” but we took it to the next level and determined that this value should be “honesty.” We also identified “customer service” as another value, but later redefined in a broader context to mean being “patient focused.”

Fourth, while it is one thing to state your values, it is quite another for everyone to agree on the specific behaviors that define those values. Although the exercise to determine our values worked well as a team project, we soon found that the “drivers” on the team were providing most of the input, and that the “stabilizers” and “analyzers” were not offering anywhere near the amount of input for defining behaviors.

As a result, we formed a strategic team that allowed us to systematically define key behaviors that would support our values. This special team enumerated on those values, as well as expanded and interpreted how those values will be put in place (by defining specific behaviors that reinforce each one). They also explained how values influence everyone’s jobs and how they contribute to the overall success of the practice. When this was completed, we shared the final product with the entire team, discussed the overall plan and obtained their buy-in.

A side benefit of working through the various aspects of developing an effective communications plan allowed us to focus on our team, and the assembly of teams within the team. We identified our entire staff as giving us a strategic advantage. We conducted administrative, tactical, strategic and developmental meetings with team members. Individuals participating in these teams were identified as coordinators, leads, captains, ambassadors as well as those with aspirations to move up within the practice.

All of this planning and careful implementation led to the development of our new communications culture we call Beyond the Language of Trust – which has become a culture among our own internal decision makers and staff members. In leading our employees through this process, I also gave them tools needed to succeed, and trusted them to make informed decisions in keeping with our overall strategy and business plan. At the same time, they now trust me. However, the most important outcome is that they trust me to trust them.

Malcolm Gladstone said, “Communication succeeds or fails on its ability to engage you, make you think and give you a glimpse into someone else’s head.” From a leadership perspective as a catalyst for change, radio newscaster Edward R. Murrow put it best. “To be persuasive we must be believable. To be believable we must be credible, and to be credible we must be truthful.”

Effective communication depends on understanding, cooperation, trust and trustworthiness, according to Steven R. Covey. It is an essential component of professional success at the interpersonal, intergroup, intragroup, organizational and external levels, whether you are part of an audiology practice or any other entity working with employees, patients and clients.
6 Tips for Creating Candor
Here are six tips covering some of the techniques we have found useful when seeking candid feedback from patients and our staff, as well as when identifying issues and planning to implement improvements in the practice and our communications process at Audiology Associates.
  1. Send satisfaction surveys to every patient seen. As they come in, their comments and scores are tabulated and discussed in a candid format at our team meetings. As a side benefit, these questions and discussions often generate ideas that transform the meeting from a self-congratulatory event into a stimulating working session.
  2. Analyze surveys to aid in problem solving. The idea is to help team members become decision makers solving problems and creating solutions – as well as to determine whether these problems have anything to do with their respective departments.
  3. Conduct one-on-one meetings with staff members. We do this on a monthly basis as well as semiannually and by different strategic team members to gain other perspectives and insights. Some organizations conduct 360-degree reviews to test interpersonal relations and communication skills across departmental boundaries as well as among managers and subordinates.
  4. Know each team’s strengths and weaknesses. Determine these characteristics for groups as a whole as well as for individual participants through self-assessment surveys, profile evaluations and performance reviews.
  5. Identify and develop ways to overcome communication barriers. Develop a remediation plan when issues are identified so that obstacles to effective communications can be resolved, and then revisit each identified situation to see if the action plan has been effective, or if additional support is needed.
  6. Stimulate staff member involvement. Balance teams with “drivers, stabilizers and analyzers” to foster active contributions from each member and to draw them out to provide input as the team addresses concerns and opportunities.
Peter Marincovich, Ph.D. founded Audiology Associates in 1984 and is currently celebrating 30 years in business. The firm has three locations: Santa Rosa, Mill Valley and Mendocino, California. The practice includes a professional staff of four audiologists and three audiology assistants supported by seven administrative employees.