Listening and the Tug of War

She seemed agitated to say the least. The CEO of the health clinic pulled us aside in the middle of a break. Had we done or said something to upset her? We took a deep breath as our faces turned crimson and then were drained of color.

“Well, you stepped right into the fray, didn’t you?!  That doctor and I have been in a game of tug of war for months.  He wants to spend more time interacting with his patients: listening, empathizing, building relationships.  But he doesn’t appreciate that as the CEO I need to justify our billable hours for funding purposes. He doesn’t seem to understand my role being responsible for the bottom line and the position I’m in!  I need you to know about this conflict and tension. There are two sides here, competing against one another.
It’s not a simple place to be.”

As we listened and tried to affirm the tension she was in, we tried our best to remain neutral, not grabbing the rope against one or the other in their game of tug of war.

That tug of war occurred in the middle of leading a compassionate listening training, an increasingly growing program of Someone To Tell It To.  A few moments earlier we had made the point that doctors, nurses, palliative care teams, social workers, and chaplains need to take the time to listen to patients so patients know how much they care. We quoted poet Maya Angelou, who is famous for saying, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel”. We agree.  The doctor in the tug of war raised his hand after we quoted her, saying: “I make it a priority to #listenfirst to understand.  The challenge for us is that we have an allotted number patients we are expected to see on any given day. How do we listen well when we have regulations forcing us to meet quotas?  It’s a constant tension.”

We realized in the moment that the CEO was having a struggle understanding the position her clinicians were in as they tried their very best to build patient rapport, something many health care agencies are emphasizing today.  Her clinicians didn’t understand the role she was accountable for in trying to achieve expected numbers to maintain the necessary funding to ensure continuation of their programs.

Or perhaps they did understand one another.  But there just aren’t enough hours in the day or dollars in the bank to do all of these things well.  So sacrifices and compromises are made.

One side tugged on the rope.  The other side tugged back. Harder.  And truth be told, we understood the tension.   We truly did. We understand all too well, from experience, the fact that without the dollars, excellent programs cannot be carried out.  But we also know, from experience, how important it is to build trust and an empathetic rapport as the foundation for healthy relationships and environments.  

Studies are suggesting that doctors underestimate the severity of their patients’ physical symptoms, discounting the patients’ understanding of their own conditions.  To read more about this problem, we invite you to read this Boston Globe article – “The Clinical Value in Listening”,

In our listening work, we’ve heard similar stories from other industries and organizations.  Bosses aren’t listening to their team members, because bosses have too much to do. Team members don’t feel heard, because bosses aren’t listening to their ideas.  Low level employees feel pressured to achieve certain objectives, set by higher-level employees, and therefore don’t have the necessary time, nor qualifications, to listen effectively to their clientele.  One side pulls the rope, not listening to the other side, the other side pulls the rope harder, creating more tension in their work cultures. The struggle is real.

One woman, who works in a clinic for cancer patients, expressed her immense frustration to our listening team, much as the doctor did, that she isn’t given permission to listen to her patients as much as she knows they need to be listened to.  “I hate it when the patients don’t think I care about them. In makes me feel as if I’m not empathetic towards their needs.”

Another friend of ours, Sarah Thebarge (a recent guest on the Someone To Tell It To Podcast), shared a story in her book, The Invisible Girls, about an interaction she had with a chaplain when she was hospitalized for breast cancer surgery:

A hospital chaplain came to see me after that.  She had a hard time making eye contact, and wouldn’t sit down in the chair I offered her.  Instead, she stood in the doorway, one foot in the room and one foot in the hall, as if ready to bolt at a moment’s notice.  She asked me what I needed.

Maybe other patients would have been superficial and polite, and just asked for ice chips or a quick prayer, but I was honest with her.  I told her I needed someone to tell me how God could allow someone He loved to suffer so much when I wouldn’t do this to someone I hated.

She fidgeted and took a step back, until both of her feet were in the hall, and her head was poking through the doorway.  She said, “I’ll look that up and come back.” But I never saw her again.

So, is the problem that health care agencies and clinicians (i.e. doctors, nurses, chaplains, etc.) don’t have time to listen or is it that they don’t feel it’s important to listen?  As a non-profit organization, we understand the need to reach the highest numbers of people we can reach for grant purposes, quotas, and goals. But we also believe wholeheartedly that the two sides aren’t mutually exclusive.  You can pull the rope one way, serving the greatest number of people for the greatest good, without sacrificing the gift of listening in order to understand those we are serving.

How do we find that healthy balance?  First, we’d suggest that organizations be part of Someone To Tell It To’s Culture of Care training.  Through it, we express several guiding principles to help build stronger relationships.  One very basic principle we can share here, is to suggest that all of us try asking these four words to gain a connection with and appreciation from others, one we learned from the extraordinary National Public Radio Fresh Air interviewer, Terry Gross: “Tell me about yourself.”

Tell me about yourself.

In our hyper-connected world, by asking those four simple words, we are fostering a more authentic relationship.  Scroll the comments on social media and you will see how much we all love to talk about ourselves. By asking those four simple words – and then genuinely listening for a response – you will be making others feel valued, heard, and that their lives and stories matter.

These are basic, universal human needs.  

That tug of war between the CEO and her staff doctor doesn’t need to happen.  It’s possible for both of them to do the very best at their jobs – and not be in competition with one another, but instead to enhance one another’s responsibilities in the process.  Everyone can be happier and better served when they do.