PAs as Facilitative Leaders: Utilizing the PA to Build a

Healthy Organizational Culture

Andrea Lombardi, BA, MBA, BHScPA, CCPAOctober 25, 2014

I have no disclosures or conflicts of interest in this presentation.

1. Introduce concepts of facilitative leadership

2. Draw parallels between communications skills taught in PA curriculum and facilitative leadership approach 

3. Open floor to interactive discussion

Objectives

The Skilled Facilitator (2002), Roger Schwarz

The Skilled Facilitator Field Book (2005), Roger Schwarz et al

www.schwarzassociates.com

Facilitative Leadership Approach

Approach to leadership and group decision making

How one thinks is how one leadsHelps leaders shift beliefs, thus changes way they lead

Facilitative Leadership Approach

I understand some things. So do you. Let’s learn and move forward together.

Unilateral Control

I understand, you don’t. I’m right, you’re wrong. I will win.

Facilitative Leadership Approach

An Illustrative Contrast

Unilateral Control Model

Source: Adapted from Argyris & Schön, 1974, and Action Design, 1997.

I understand the situation; those who disagree don’t

I am right; those who disagree are wrong

I have pure motives; those who disagree have questionable motives

My feelings and behavior are justified

I am not contributing to the problem

1.State my views without

asking for others’ views and vice versa

2.Withhold relevant information

3.Speak in general terms and

don’t agree on what important

words mean

4.Keep my reasoning private;

don’t ask others about their

reasoning

5.Act on untested assumptions and inferences as if they

were true

6.Control the conversation

7.Focus on positions, not interests

8.Avoid, ease-in to, or save face

on difficult issues

9.Use an arbitrary decision rule

or don’t discuss it

Lower quality decisionsIneffective solutionsUnnecessary costs

Decreased commitmentPoor follow through on decisions Solutions that don’t stick

Longer implementation times

Strained working relationships

Reduced trustDefensivenessUnproductive conflictInappropriate

dependence on others

Less personal satisfactionMissed opportunities for growth and developmentUnnecessary stress

Decreased learningMisunderstandingDenial and blaming

others for mistakesRigidity

Mindset Behavior Results

Win, don't lose

Be Right

Minimize expression of negative feelings

Act rational

AssumptionsValues

Facilitative Leadership Approach

Source: Adapted from Argyris & Schön, 1974, and Action Design, 1997.

I have some information; so do other people

Each of us may see things the others don’t

I may be contributing to the problem

Differences are opportunities for learning

People may disagree with me and have pure motives

1.State views and ask

genuine questions

2.Share all relevant information

3.Use specific examples and

agree on what important

words mean

4.Explain reasoning and

intent

5.Test assumptions and

inferences

6.Jointly design next steps

7.Focus on interests, not

positions

8.Discuss undiscussable

issues

9.Use a decision-making

rule that generates the level of commitment needed.

Higher quality decisionsInnovative solutionsCost savings

Increased commitmentFollow through on decisionsSolutions that stick

Shorter implementation times

Improved working relationships

More trustLess defensivenessProductive conflictAppropriate dependence on

others

Greater personal satisfactionIncreased growth and developmentLess stress

Increased learningGreater understandingEmbracing and learning

from mistakesGreater adaptability

Mindset Behavior Results

Transparency

Curiosity

Accountability

Informed Choice

Compassion

AssumptionsValues

Mutual Learning:◦Midset Values Assumptions

◦“Ground rules” - behaviours◦Results

Facilitative Leadership Approach

Transparency – sharing relevant info, including thoughts, feelings, intentions

Curiosity – being genuinely interested in others’ views; recognizing other people have info that you do not

Accountability - accepting responsibility for actions and consequences

Mutual Learning Mindset: Values

Informed choice – making decisions and maximizing others’ abilities to make decisions based on relevant info in way that builds commitment

Compassion - willing to temporarily suspend judgment to appreciate your own and others’ situations

Mutual Learning Mindset: Values

I have info and so do other people People may disagree with me and still have pure motives

I may be contributing to problem Each of us sees things others do not Differences are opportunities for learning

Mutual Learning Mindset: Assumptions

1. State views and ask genuine questions2. Share all relevant info3. Use specific examples and agree on what

important words mean4. Explain reasoning and intent5. Test assumptions and inferences6. Jointly design next steps7. Focus on interests, not positions8. Discuss “undiscussable” issues9. Use decision making rule that generates

commitment level needed

Mutual Learning Behaviours

Provide more guidance than procedural or abstract ground rules

Shorter implementation times Increased commitment Higher quality decisions Increased learning Improved working relationships Greater personal satisfaction and well-being

Mutual Learning Results

You are a PA working in an inpatient ward of a hospital

On a recent initiative conducted by Infection, Prevention and Control, your team scored lowest on proper hand hygiene audit

Your team consists of a physician, nurse, pharmacist, physiotherapist, social worker, and students (and yourself, the PA)

You are meeting with your team

Case Example

1. State Your Views and Ask Questions

© The New Yorker Collection Robert Mankoff from cartoonbank.com. All Rights Reserved.

State your point of view and explain your reasoning

Avoid rhetorical or leading questions ◦ “Do you really think will work?”

Ask genuine questions that stem from curiosity◦ “I’m not seeing how this will work because of x.

What are you seeing that leads you to think it will work?”

1. State Your Views and Ask Questions

Help create common pool of info that everyone can use

Relevant information – anything that might affect decision

People underestimate dangers of not sharing relevant information

Feelings ARE relevant

2. Share All Relevant Information

3. Use Specific Examples and Agree What Important Words Mean

https://www.pinterest.com/pin/178103360235496402/

We use A LOT of jargon and abbreviations

PAs are team-based, inter-professional clinicians, we don’t just communicate with physicians and nurses!

Shared understanding is key to decision buy-in

3. Use Specific Examples and Agree What Important Words Mean

We are hard-wired to make meaning out of events

Providing explanation helps reduce others making assumptions

Sharing your reasoning more transparent trust

Be curious, and ask others to do same

4. Explain Your Reasoning and Intent

5. Test Assumptions and Inferences

© The New Yorker Collection Cheney from cartoonbank.com. All Rights Reserved.

Assumption – taking something for granted, without any info

Inference – drawing conclusion about things you don’t know, based on things you don’t know

Step 1 – awareness Step 2 - identify what other person said/did that led to your inference

5. Test Assumptions and Inferences

Advocate your point of view, inquire how others see it, jointly craft next step

This invites people to share their thoughts and challenge status quo

Inviting team members to actively participate in designing solution translates into stronger buy-in

6. Jointly Design Next Steps and Ways to Test Disagreements

Interests – criteria that need to be met in order to solve problem in way people support

Interests motivate people, can be quite fixed

Positions - what people think will serve their motivations, can be very flexible

Focusing on interests creates more options for potential solutions that meet those interests

7. Focus on Interests Not Positions

8. Discuss “Undiscussables”

8. Discuss “Undiscussables”

Issues not discussed openly by team Relevant to team’s work Often discussed everywhere else except team

Reduces team’s effectiveness Most difficult ground rule Approach with compassion

Group decision-making process types:1. Unilateral2. Delegative3. Consultative 4. Democratic 5. Consensus

When you need greater commitment to ensure decision is implemented effectively, it makes sense to have greater involvement in process

9. Use a Decision Making Rule that Generates the Level of Commitment

Needed 

Communication Skills Taught in PA Curriculum

https://www.pinterest.com/explore/medical-jokes/

1. Initiate session◦ Establish initial rapport◦ Jointly design reasons for consultation

2. Gather information◦ Encourage patient to tell their story◦ Ask open ended questions◦ Listen attentively◦ Clarify ambiguous terms◦ Encourage patient to express feelings

Calgary-Cambridge Guide to the Medical Interview

3. Provide structure◦Structure interview in logical sequence

4. Build relationship◦ Use appropriate body language◦ Develop rapport, use empathy◦ Be non-judgmental◦ Acknowledge views and feelings◦ Share thinking

Calgary-Cambridge Guide to the Medical Interview

5. Explain and plan◦ Provide information◦ Elicits patient beliefs, reactions◦ Shared decision making about next

steps◦ Ensure all concerns addressed

6. Close session◦Summarize session◦Final check

Calgary-Cambridge Guide to the Medical Interview

Builds relationship: shows interest in patient, uses body language appropriately

Opens discussion: asks questions to elicit full set of concerns, negotiates an agenda for visit

Kalamazoo Observation Guide

Gathers information: asks open-ended questions, clarifies details, asks what is meant by ambiguous language to better understand the patient’s story

Shares information Reaches agreement Provides closure

Kalamazoo Observation Guide

Conversation about change (counseling, therapy, consultation, method of communication)

Collaborative approach (person-centered, partnership, honors autonomy)

Evocative approach (seeks to call forth person’s own motivation and commitment)

Motivational Interviewing

Approach:◦ Open-ended questions◦ Affirmations◦ Reflections◦ Summaries

Motivational Interviewing

Discuss utilizing PAs as facilitative leaders to build healthy organizational culture

PAs are trained in models for communicating with patients, which are directly aligned with facilitative leadership approach to leadership and team-based decision making

Thus, PAs are well positioned to be facilitative leaders within organizations to help build stronger, healthier working culture

In Conclusion…

This will translate into improved: rapport with physicians and allied health professionals, problem solving, outcomes, quality of work life, patient care, etc.

Will also help strengthen reputation of PAs as leaders, and thus profession in Canada

In Conclusion…

Calgary-Cambridge Guide to the Medical Interview Kalamazoo Observation Guide Leadership Retreat, Oncology Program, Sunnybrook

Health Sciences Centre (Oct. 15, 2007, Oct. 24, 2008., Nov. 16 & 17, 2009)

The Skilled Facilitator (2002), Roger Schwarz The Skilled Facilitator Field Book (2005), Roger

Schwarz et al www.motivationalinterview.org/quick_links/

about_mi.html www.schwarzassociates.com

References