Fig. 27.1
The Leary circle (Adapted with permission of Wipf and Stock Publishers (www.wipfandstock.com) from Leary T. Interpersonal Diagnosis of Personality. New York: Ronald Press; 1957; republished 2004 by Wipf and Stock Publishers, New York.)
The quadrants in this model represent several forms of cooperation or opposition that we can use professionally to steer others or even the group in the direction we want. For instance, if the person chairing a multidisciplinary meeting displays too much leading behavior, this will often evoke passivity in other people at the meeting: They become followers instead of participating actively and helping the group. This can manifest itself in different ways: Some people become passive-aggressive (rebellious), while others withdraw. At best, the chair will gain followers or cooperators. To entice other people at the meeting to really participate (help), the chair will therefore have to avoid being dominant all the time (leading) and sometimes show following behavior. Since in health care the health and well-being of the patient is the main focus (patient centeredness), we sometimes forget that collaboration is a process that we ourselves must actively and consciously shape. This methodical approach to collaboration, known in contemporary jargon as relations management, requires numerous skills that go considerably further than having learned discussion techniques. Professional collaboration means that collaboration must be well organized, preferably in accordance with best practices and evidence from research. In short, good collaboration also requires good organization. This reciprocity applies to all the soft skills in models such as the CanMEDS roles and the “learning organization” concept.
27.4 Feedback as Interpersonal Coordination
If people are to react to each other adequately, they need to be able to influence each other. One of the most convenient ways to do this is to use feedback. Feedback is always and everywhere a crucial prerequisite for collaboration, but it can vary widely across different cultures. Gender, age, and, of course, personality and character also play a role: One person is a perfectionist who wants to have everything under control, another takes things as they come. Moreover, ingrained behavioral patterns play a role in giving and receiving feedback. This is certainly the case in teams who have known each other for a long time. Usually all these things result in familiarity with each other. They make our behavior predictable, and that is pleasant. We know where we stand and can focus on the content of the discussion. This does not alter the fact that feedback always requires sensitivity, especially if it involves criticism. However, it is also important to realize that feedback is a lot more than saying that we would like certain things to be different. We also use feedback to reward desirable behavior: Compliments are also feedback. Holding up a mirror so that the other person can improve their own behavior is also a form of feedback. Although the term feedback is in itself neutral, feedback itself nearly always has a certain tone. It is nearly always either an expression of approval or rejection or the absence of a reaction—ignoring someone is also a signal, and in fact often a very strong signal. If we ourselves are the subject of discussion, as Verda is in our case, the feedback is directly about us and may therefore be hard to take. Finally, it is important to realize that feedback also always reflects the opinion of the person giving it. This means that feedback always also says something about us, regardless of whether we are giving or receiving it. Particularly in situations in which people are vulnerable, it is important to be very careful about this personal aspect, whether it is about us or someone else.
Case History: Continued
After Margareta’s fierce tirade, silence falls. Although everyone is aware of Margareta’s commitment to her patients, people sense that a certain boundary has been crossed. The chair, the eloquent Carlos Amarillo, an obstetrician originating from Madrid in Spain, is also aware of this and wants to call Margareta to order. Fortunately Carlos thinks again. He realizes that he has a responsibility not to make the same mistake as Margareta has just made. “Practique lo que predica!” Practice what you preach! To be effective, feedback must relate to behavior that can be changed, but what is even more important is that the other person must be able and willing to be helped by the feedback.
Carlos as an experienced chair knew better than anyone that the core of the problem was exactly this. Criticism of a person’s emotions, including the absence of emotions, is not helpful, because it is not acceptable. He decides to opt for a two-pronged approach: Be hard on the problem but soft on the person, and always start with this second aspect. “Margareta, we all know how committed you are to your patients and because of that you are certainly entitled to be surprised at certain things. You’re welcome even! But what exactly did you want to achieve with your comment?”
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