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Francine R. Gaillour, MD, MBA, FACPE Daring Doctors



Handling Tense Situations: The Nonviolent Way

Recently I've been an attendee at a couple of meetings---one, a community coming together to discuss the possibility of hosting a Tent City; the second, a group of physicians coming together to discuss a possible separation of several of the members.  I noticed how easily some of the participants fell into the mode of using violent language to make their point.   More troubling, they frequently invoked moral and ethical principles to support their anger.  They probably didn't think they were being "violent" but the effect was to intimidate and "shut up" people with different points of view.  

Ever been in a tense meeting like that?  What's a good approach to defusing meetings and situations that threaten to get out of control into and turn into a verbal torrent of anger? 

The Nonviolent Communication Model

Marshall Rosenberg, PhD, founder of the Center for Nonviolent Communication, has spent most of his professional life teaching Nonviolent Communication (NVC) as a method to create dialogue, connection and collaboration.  The objective of NVC is to get to the underlying emotions and needs at the heart of of angry discourse, and then steer parties to understanding.  

Rosenberg' model for nonviolent, constructive communication has Two Parts:  

1) Empathetic Listening 

2) Honestly Expressing

Each part, then, is comprised of the same FOUR components or "steps" that we should walk ourselves through, in order to create collaborative dialogue:

  • Observations

  • Feelings

  • Needs

  • Requests

First, Be an Empathetic Listener

Imagine yourself in the middle of a particularly tense meeting among physician members of a large group, and the group is veering from a tense confrontation to angry diatribe.  First, assume the role of Empathetic Listening.  Here are your four steps in action:

a) Observations -- What is the body language of the other person? Or, what is the behavior of the person or group?  You might say something like:  "I notice that that several people are raising their hand to speak; this is a topic a lot of people want to have a say in." Or, "I notice that this topic is really important to you."

b)  Feelings -- What are the feelings being expressed by the person speaking?  Can you identify them, or is the person telling you what his/her feelings are?  You might say something like:  "What I hear that you are angry about how this is being handled."  or "I can hear that you are disappointed about this."  

c) Needs -- What are the underlying needs being expressed by the person speaking?  This is often the most difficult to discern because, as the listener, you will be tempted to jump into a defensive mode, rather than stay calm and probe for the deeper needs of the speaker.  You might say something like: "Based on what I'm hearing, what could be an important issue here is having more people involved, and then having them develop a broader sent of choices" or "What might be an issue here, based on what you've said, is that this decision could affect our collegiality and the general stability of the practice."

d) Requests -- What is the person requesting?  They may be explicit about the request, or you may want to guide them to a request.  This is an important step in  creating a "give and take" in the dialogue.  You could ask them directly: "What would you ask of us/the group/organization right now so that you can start to feel better about this?" Or you can clarify what you think is the request:  "What I think I hear  you saying is that you request we reorganize the governance structure altogether?  Did I understand that correctly?" 

Next, Express Yourself Honestly and Respectfully

Now assume you will be a participant and speaker at a highly charged meeting.  Sadly, what I have found is that some people seem to pride themselves on the eloquence of their angry outburst and will wax eloquently as vile spews from their mouth. Furthermore, they are often applauded for their gumption by others who are less apt to yield a verbal club.  Please don't go down that road! If you truly want resolution, go the NVC route.

Take a few moments to mentally prepare your remarks incorporating the four components of Honestly Expressing.  Here is an example:

[Observation] "I noticed that some of members of the group are getting preferential referrals, when we had agreed last year that we would rotate the new referrals.  I say this based on reviewing the administrator's summary of new patients over the past 4 months.  I also have observed that some of us have not been included in or notified about Executive committee meetings, the agenda or the results of discussions." 

[Feelings] "I'm feeling pretty angry about this, and frankly really disillusioned  about our whole group mission. This makes me feel like a second class partner in the group; like I'm in the doghouse, but I don't know why.  

[Needs] "When I joined the group a few years ago, we had a real atmosphere of trust.  We shared openly the information about our financials; we've always treated each other fairly. It's important to me that we value each person and be fair."

[Request] "What I request is that we have rotating members of the executive committee every six months so we have more people in the know.  An that we stick with our referral rotation as we had before unless we ALL agree it has to change.  And then maybe set up a committee just to look at whether we need to have a different rotation, and they can come up with specific reasons and recommendations."

Next time you attend a meeting, jot down  these  four components of the NVC model on an index card or Post-It Note:  Observations, Feelings, Needs, Request.  Let these serve as a reminder and guide to help you frame the conversation for collaboration and connection. 

Francine R. Gaillour, MD, MBA, FACPE is an executive coach and business consultant.  She is president of The Gaillour Group and director  of Creative Strategies in Physician Leadership.  Dr. Gaillour is a professional speaker on healthcare leadership,  cultural change and physician professional development.  

She can be reached at (888) 562-7289 or francine@physicianleadership.com

10 things we can do to contribute to internal, interpersonal, and organizational peace

(1) Spend some time each day quietly reflecting on how we would like to relate to ourselves and others.

(2) Remember that all human beings have the same needs.

(3) Check our intention to see if we are as interested in others getting their needs met as our own.

(4) When asking someone to do something, check first to see if we are making a request or a demand.

(5) Instead of saying what we DON'T want someone to do, say what we DO want the person to do.

(6) Instead of saying what we want someone to BE, say what action we'd like the person to take that we hope will help the person be that way.

(7) Before agreeing or disagreeing with anyone's opinions, try to tune in to what the person is feeling and needing.

(8) Instead of saying “No,” say what need of ours prevents us from saying “Yes.”

(9) If we are feeling upset, think about what need of ours is not being met, and what we could do to meet it, instead of thinking about what's wrong with others or ourselves.

(10) Instead of praising someone who did something we like, express our gratitude by telling the person what need of ours that action met.

The Center for Nonviolent Communication (CNVC) would like there to be a critical mass of people using Nonviolent Communications language so all people will get their needs met and resolve their conflicts peacefully.

© 2001, revised 2004 Gary Baran & CNVC


Francine R. Gaillour, MD, MBA, FACPE
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Francine R. Gaillour, MD   ©2006 Ki Health, Inc.