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A Communication Framework for Having the Tough Conversations w/Mike Lalor Ep#146

By Anthony Taylor - January 27, 2022

SME Strategy is a strategy consulting company that specializes in aligning teams around their vision, mission, values, goals and action plans. Learn more about how we can help align your team with our strategic planning and implementation services.

Untitled design - 2021-12-27T131748.040  Anthony: Hey there, folks, Anthony Taylor here. I'm the Managing Partner at SME Strategy. And this is the Strategy & Leadership Podcast, where we interview experts and thought leaders from around the world to get their perspectives on leadership and how to drive organizational performance. And today, my guest is Michael Lalor, who is the Chief Medical Officer at Trellis Supportive Care. Mike, how's it going today?

Untitled design - 2022-01-26T142350.804  Mike: Good. Excellent Anthony, how are you? Thank you for having me today.

Anthony: I'm excited to chat. So why don't you tell our listeners a little bit about who you are and your body of work that led you up until today?

Mike: Surely, my name as he said, Michael Lalor, I'm the Chief Medical Officer of a large hospice and palliative care agency in North Carolina called Trellis Supportive Care. I've been a clinician for about 22 years, and the last 10 years or so of my career transitioned into the area of physician leadership, as opposed to being a direct care clinician.

Anthony: Awesome. And so, you know, through that transition, what would you say are the - call it parallels, but it may have similarities and differences between being a clinician and being in the type of leadership for clinicians?

Mike: Yeah, there's a lot of parallels, there are skills that carry over to help you become an effective leader. But there's also a lot of things that are very the opposite of what makes a good physician and I can highlight a couple of examples of both. So on the parallel side things that can make you a good physician and make you a good physician leader. In my field, a lot of what we do is have difficult conversations. I focused on an area of care, that's a little unique - end of life care. And a lot of what we would do there is delivering bad news, clarifying goals of care, aligning someone's goal of care with a realistic treatment plan.

And as I started transitioning into areas of leadership, I found that a lot of those skills were exactly the same. Delivering bad medical news is very comparable to giving someone a performance evaluation, potentially telling them that they weren't quite meeting their objectives, division rearrangements, all of that is a very comparable skill set. Now, on the other side, a lot of people think that because they were a good physician, that potentially it will make them a good physician leader. And I think that a lot of the things that make individuals good physicians actually make them bad leaders. So much of being a physician is about your individual performance, being the best of the best. You know, I'm the smartest person in the room, and I'm going to let everyone know about it. And those are things that will serve you very poorly as leader.

Anthony: I definitely want to ask about that because I find that there's some people who are good practitioners and business owners, often they're good at delivering, but then when it comes to the leadership, it's a whole different set of skills and attributes. So I'm curious about that. But I do want to ask, from a practical standpoint, are people in medicine trained on saying, Hey, if you're gonna give somebody bad news, here's the framework, or here's the structure, or here's the kind of mental state I put myself in to deliver. Arguably, one on hand, some comforting news. But on the other hand, a very difficult thing. So how do you do that in a way that's effective?

Mike: Yeah, I think in general, in medicine, it's likely done poorly. I think we can do a better job at it. It's kind of brushed over, there's not a formal structure inside of most medical school training. But my specialty really revolves around that. So if you ended up doing something where you have more of a clinical interest, there's great training available for you. And exactly like you said, there's very structured ways of having a lot of these conversations, to make sure that you're able to deliver the news in a way that will be received well, that you can tease out what's really important to an individual, and how you compare this with things that are realistic based on where they are. So there are resources available, I just wish they were more widely diffused across all of medical training.

Anthony: Is they're one tool or one approach or one consideration practically, that you'd want to give to our listeners, whether they are or aren't in the medical field?

Mike: Most certainly. One I turn to quite frequently is something called the SPIKES protocol. And what the SPIKES protocol is, it's a mechanism of delivering less than favorable news doesn't always have to be hardcore bad news. But for something that could be emotionally difficult, like a challenging conversation, it's a great framework. What the SPIKES protocol is, it stands for setting perception, invitation, knowledge, emotional response, and then next steps. And what this is, it's a way to really communicate this news in a non threatening manner, get the point across and recognize the individual's needs.

>>Watch more: How to Design Conversations that Matter

So, setting. If you're delivering bad news, whether it be in a medical situation or work situation, you don't want to do it in a big room. You don't want to do it where it's noisy, where there's distractions. If you were delivering news that was really emotionally charged, you may want to be prepared by having tissues in the room, comfortable sitting, making sure that it's lit, perhaps putting yourself at eye level to someone. If it's going to take time, take off your jacket. So really make sure that the setting is appropriate to receive the knowledge.

The next thing is so often people go into a conversation, whether you're a doctor or a leader, thinking that everyone has the same understanding that you do about the situation. You make this assumption right off the bat. That doesn't do anybody well. So the next part, the P - perception. You ask the person you're speaking to, what's your understanding of what's going on here today? If it was a business setting, maybe what do you think we're talking about today? Are you aware of what went on? This way, you can see what their understanding of the situation is beforehand, and not jump to conclusions.

Next part, the I, is an invitation. I just want to make sure it's a good time to have this conversation. Anthony, unfortunately, got some bad news to deliver - Is this a good time for you? Really making sure that it's something that the other person in conversation is prepared to receive. If it's one of your co-workers, they may be busy facing a deadline, they may say, Anthony, I gotta talk to you later. You know, can we do this another time? Or no, this is a good time to sit down.

K. Knowledge is simply delivering the information. Anthony, I got some bad news. You know, we talked about your performance goal for the last quarter, you're nowhere near it. Whatever it may be, deliver it, you're factual. You're not accusatory. Look to get the other person's understanding of it. But you're delivering the knowledge that you intend to.

If it's really, really bad.. the next part is E, emotion. And you need to expect an emotional response, prepare yourself and have some potential positions ready. In order to have the discussion, someone could be angry, and very accusatory. You gotta know how to deal with that. A lot of times in a medical setting, we're going to deal with someone who's you know, emotionally upset, crying. How do you respond to that? And there's some cues, there's some things you can do to tease out the emotion - you seem upset? This information seems upsetting to you? Can you explain further.

So you go through that pathway, and then you set up the next steps. Okay, based on what we talked about today, Anthony, you know, here's your performance goals. We didn't get here. Here's the improvement plan we put into place, let's follow up in a month. So you got to have the next steps of follow up. Otherwise, you're just dumping something in the lap. I have found that tool to be so helpful in my career and my personal life, you know, Hey, hun, I got something I need to talk to you about, is this good time? As apposed to just walking in the living room and you know, the kids are doing bad, I gotta go. The dealing with emotional response is an excellent tool no matter what you do.

Anthony: Yeah, I love that. Like, I've actually never heard that one before. So setting perception, invitation, knowledge, emotional, and then next steps. So having a framework, you know, some people overthink to themselves. If you're one of those over thinkers, you know, it's methodical. I don't want to be prescriptive, but in order to be effective, you do need to have a framework. It's not like a pilot just goes up in the air and says, Yeah, I'll wing it this time. You need to have that system. Two things I thought of with this one was the movie Moneyball - he has to come in and tell somebody he's traded. There's a system to just be aware, make sure you sit down, make sure you're professional, tell them the next steps. And then they get grounded in that. One that didn't go well was that CEO recently that let a bunch of people go through Zoom fairly coldly. He should have listened to this podcast before doing that. And I think he probably would have dealt with less backlash.

But I really like that. And I think it helps the listener, because at the end of the day, in your role, especially in those situations that are arguably, and I've been in those situations, the most challenging things you're ever going to experience in your life. And so really having a framework so as the message deliverer, you can be as helpful as possible to the receiver in one of the most challenging times they're going to have in your life. Any other thoughts on that?

Mike: One - I would agree that CEO definitely failed the 'S' part. Zoom is not the right setting for that. But what you highlight there, Anthony, is another excellent point, which is leadership is not about you. It's not about the way I'm going to perform in that room and how I deliver the message. The reason why we do this is to make the message well received by the other, and actionable. So this is really, you know, you do a little better, but you're doing better by doing better for the individual you're talking to. Maybe if it's a patient, making them more likely to follow the plan or have a better understanding of the plan. If it's an employee helping them with their growth, their development, potentially being retained. So it really puts the focus on the conversation where it should be, which is the other person.

Anthony: Yeah, absolutely. I love that. A leader is supposed to develop those around them. One of the things that we do in our practice, we have our alignment, where we do the strategic planning. We have our accountability, but part of that accountability, and part of what good leaders do, is supporting the development and growth of your people. So not just you developing them, but them developing everyone else. Because otherwise you can't, I mean, I call it scale, but you can't grow any organization's capacity if everybody's at the same level. So actually, I have a segue about that. In my experience, working with smart people, like really smart people, it requires a unique level of communication. So how do you as a leader, lead really smart people who are at the top of their field, but also very intellectual? Have you found that there's a particular art or science in dealing with really, really smart intellectual people in organizations?

Mike: Yeah, there's certainly a risk in doing it. But at the end of the day, we're all humans. And I look at it as having to almost separate the two sides. So someone has a degree of technical expertise that we have to recognize and communicate with. But also how does that individual themselves like to receive knowledge? Some people are very verbal, some people are very written. You have to tease out what their preferred mechanism of receipt is, and then separate it from their technical expertise. The difficulty that I find on a leadership perspective, is that sometimes people that I'm talking to can't separate their own technical expertise, from their individual performance.

>>Watch more: Tips for Building a High-Performance Culture

So someone can be a master of their domain from, you know, best cardiologist, best physician, very bright, well respected, and make the assumption that that makes them good in all domains. Because I'm very smart in this, therefore, I should be the most respected in leadership. And I think that's where a lot of physician leaders get tripped up on their first experience, because they were experts in their their field. They think it makes them an expert in the next field of leadership, which is does not at all.

Anthony: I get that. So I mean, expounding on that a little bit.. You've been in this field a long time, you deal with a lot of people. We're at a unique time in history where we have five different kind of demographic age groups. You've got Boomers to Millennials, and somewhere in between. Have you found similarities or differences communicating with them and leading people at those different levels? What's your experience been with that?

Mike: Yeah, I definitely think so. And I can even tell you situations where I get tripped up on it, making the assumption that people speak like I do. So as you said, I'm a little older in my career, I've been doing a little longer. I had a person who reported to me, whose preferred mechanism of communication was nonverbal and non face-to-face. They preferred electronic communication, email, text, other systems that we had in the organization. And I really wasn't cognizant of this, you know, my preferred mechanism of communication is face-to-face. And I would frequently call this individual, hey, can we talk? And deliver whatever piece of news it was, and it was totally nothing bad. And it was completely perceived as being yelled at. The person was being disciplined because I wanted to talk to him face-to-face. And that wasn't the case at all. I just was talking similar to like we're doing right now. But not being aware of that, not clarifying it beforehand, tripped me up. So there are definitely different mechanisms that people receive.

The one thing I would say is don't assume you know. It's easy to assume that people in a younger generation prefer electronic communication. People of an older generation may prefer face-to-face or verbal. Really clarify it, because I've seen this get tripped up both ways. And one of the things that I do, in course of the annual evaluations, is actually ask the question, how do you prefer to receive feedback? Verbally or electronically? It's a simple question. It just makes it all better.

Anthony: Yeah. And I've been going back to the the SPIKES model, setting and perception. You know, my neighbour right now, who's 17, is making a bunch of noise through the floorboard. Zach, turn the music down. And if I text him saying, yo, there's something - can we talk? He's gonna jump to the worst thing. Versus, you know, for you, if you're coaching somebody saying, Hey, can we talk? Okay, I want to actually talk to you, what is your understanding of the situation? Are you walking into our meeting thinking that I'm going to yell at you? Or are you just recognizing, hey, we just need to work through this report. And I just need your thoughts on that. Flipside, how have you found communicating - what are the requirements for effective communication with people that are later in their career, and maybe you're even younger than they are?

Mike: I think with everyone, extend appropriate respect, you know, because someone reports to you, doesn't mean they're not experts in what they do. It doesn't mean that their positions are invalidated. And as you go on to someone who has a lot of career experience, but who may not be at the career level that you are, you need to recognize that. I think it's important to say, hey, you have expertise here, I may be younger, you do report to me, there's a difference in the relationship. But I don't want to invalidate your experience, really recognizing that as important.

Anthony: I mean, that's gold, because that's the challenge. What I'm also seeing in the marketplace is you have people who've had senior leadership positions for a long time, they're kind of retiring and leaving. And then you have younger leaders in their 30s 40s and 50s, in that demographic range. And then they need to lead differently, and all of leadership is communication. So I think it's so appropriate to recognize and acknowledge the experience, while also having that respect of how you work together effectively. What is something that at this stage of your career you're challenged with r taking on as your next level of growth and development for yourself in your leadership?

Mike: Yeah, I think it's unique being a physician leader, because it really is looking at complete non-clinical transformation. You know, a step out of things where normally people would be like, What did you want to be a doctor for, if you're going to do that? And I think it really personally hit a level, where you recognize the impact that you can have on the patients you're taking care of, is larger by doing it at a system level than at an individual level. I've always loved being at the bedside. But now I truly understand I could do so much more for so many more people in a non-clinical role than right there by myself.

There's so much change going on right now. I think just being comfortable in that traditional VUCA environment or non-traditional, you know, this incredibly volatile environment, really positioning yourself for success in the future. When we're in, as a society, an environment that requires so much focus on the present. Everything is frankly in knots right now, it seems. But you still have to keep that eye to the future of let's get past today, and tomorrow will be different. We need to focus on growth, next strategic initiatives, success in the future, keeping that eye out there remains a challenge. The balance of today and tomorrow.

Anthony: I get that. Well, one of the things, first of all, thank you for for being on the podcast, one thing I want to acknowledge you for is the work that you do. And as I mentioned, as somebody who's experienced palliative care.. how you are treated during those situations can shape literally decades of your life, on how you perceive that situation to go. And how complete you are with like somebody's passing or something like that. And so I share that for you. But as a medical professional, y'all make such a big difference. And Mike, I've never had to deal with you as a medical professional, but I assert you've made a difference on tons of people's lives from that side of things. And I imagine you make a huge difference on people's lives on the leadership side of things. So just thank you for that and for what you do.

And then for our listeners, you know, taking what Mike is sharing in the SPIKES model, you don't know the impact you're going to have on someone's life, on someone's career, on someone's home. When you treat them with respect, with dignity, with clear communication and can support them in that transition. So really, I can't overstate how much these frameworks will help you and how much of a difference and impact they'll have on someone's life. So Mike again, for that contribution, I thank you as well. And I just appreciate you being a guest on today's show.

Mike: Very welcome. And thank you for the opportunity to speak to you and your audience.

Anthony: Oh, it's my pleasure. By the way, where can people get ahold of you? Where can they connect? Where can they learn more about what you do in your professional life?

Mike: I'll share my LinkedIn profile with everybody. You can connect it through your distribution, but LinkedIn is the best site for me.

Anthony: Perfect, and it's Michael Lalor, but it sounds like Laylor.

Mike: Exactly correct.

Anthony: Thank you. Excellent. So my guest today, Mike Lalor, who is the CMO at Trellis Supportive Care. Be sure to connect with him, you know, just be inspired by him. I'm inspired. So I appreciate it. Mike, thanks for being here. My name is Anthony Taylor. This is the Strategy & Leadership Podcast. Be sure to share this episode with somebody you care about, and subscribe, because I care about you and I want to stick around. So thanks for watching. Thanks for listening. Thanks for being here, and until next time!

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