Episode 118: How to Manage Upwards (and Sideways) with Dr Claire Edwin and Dr Keerthini Muthuswamy
Every workplace has a hierarchy. Whether you are a trainee, a colleague or a boss (or all three!), the hierarchy can influence everything from everyday working practices, to relational dynamics. However, sometimes, it can feel much harder communicating upwards than down. Many factors like fear and under-confidence can lead you to speak up less and be more hesitant to discuss issues. But building trust, and putting your voice out there will benefit your team as well as you.
Today, we have two guests on You are Not a Frog: Dr Claire Edwin and Dr Keerthini Muthuswamy. They talk about their experiences working within a hierarchical system as junior doctors and share what they have found to be essential if you want to build trust and foster good relationships with your seniors, your juniors and your peers.
If you want to know how you can build trust and influence your workplace, and manage upwards and sideways this episode is just for you!
Here are three reasons why you should listen to the full episode:
Find out why a hierarchy can be both a help and a hindrance.
- Learn how to approach conversations and which questions you can ask to build trust and good relationships with your colleagues.
- Overcome the barriers set down by hierarchies to influence your workplace for the better.
[4:56] The Impact of a Title
Claire felt that a fellowship title changed how she approached and spoke to people senior to her position.
- A title also gave her the confidence to focus and build on self-development.
- That confidence and skills she’s developed can also influence her other training.
[7:28] The Impact of a Hierarchy
The NHS is very hierarchical, and this affects the working culture.
- Everyone has a boss. Many people, including trainees, feel the effects of a hierarchy.
- Hierarchy, however, is vital for patient safety and the growth of a trainee.
- Trainees have unique experiences and backgrounds that the organisation can use to create meaningful change.
- Unfortunately, the perpetuated working culture doesn’t give trainees a voice.
[07:48] Kit: ‘…trainees come from so many different backgrounds, and have so many different experiences amongst ourselves. And I think to actually not harness that and not to make the most of it, and not to encourage trainees to kind of speak up and use their experience and diversity of thought, to influence greater changes. It’s such a shame.’
[09:58] The “I’m Just a Trainee” Mentality
The thinking that you’re “just a trainee” can be an external barrier to creating influence.
- This barrier makes it difficult to develop self-confidence — an internal factor.
- As trainees, it’s easy to let the fear and pressure of the hierarchy blind your confidence. It can also hinder you from establishing relationships.
- You need to accept the risk of being dismissed and develop the resilience to overcome that.
- You can’t change the hierarchy, but you can exert influence beyond your official position.
[10:30] Claire: ‘I think it’s actually really hard to go out of your comfort zone, if you never have if no one’s ever encouraged you, if you don’t have the self confidence.’
[14:46] Build Trust and Influence
Influence can be affected by your connections and relationships with your colleagues.
- Being trustworthy, reliable, hardworking and kind can help you build your connections.
[15:15] ‘I think it’s all about trust, demonstrating that you’re a reliable person that you are hardworking and trustworthy. I think it’s also about being kind to people.’
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- Introduce yourself and build trust in your relationship before going straight into discussing problems only.
- Opening up to others and letting others open up to you regardless of management hierarchy can improve the working environment.
- When trying to influence change, don’t focus on the people involved. Instead, think about the issue you’re trying to affect and how everyone can benefit.
[17:29] Kit: ‘If you’re expecting other people to kind of be open with you, and share their issues with you, I think you have to be willing to do the same. And I think that’s really fundamental to having a good workplace where you can share your thoughts, not feel intimidated by someone just because of their position, and kind of know that you can talk to each other and help each other when needed.’ – Click Here to Tweet This
[18:24] The Real Problem
It’s vital to separate the person from the problem
- Work out interest (why you want that) and needs (what you need to have) vs position (what you say you want).
- This knowledge can help pinpoint the roots of a problem.
- For the NHS and the professionals working there, their primary interest is the patients.
[27:46] Asking and Conversing
Not everyone would have the same motivations as you.
- Sharing and listening about what motivates others can open conversations about their reasons and suggestions.
[27:27] Claire: ‘And actually to make the job sustainable, you really do need that balance and support and resilient workplace that isn’t just kind of drawing on your empty reserves all of the time, because that that really doesn’t work. And it doesn’t do good for patients or the staff.’
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- Through these conversations, you can reach a solution where everyone is happy.
- In conversations, don’t be afraid to ask questions. Remember: you’re on the same side!
- It’s critical to know your exact objectives when negotiating.
[31:10] ‘Kit: If you know what you’re motivated by, it’s very easy to assume that that’s the case for everyone else, because in your mind, that’s the truth.’ – Click Here to Tweet This
[36:21] What Creates Good Working Relationships
Trust and good relationships are necessary for good working relationships. A good working team has members that know some context about each other.
- Don’t be afraid to approach someone no matter their position. Ask to learn more about them and build a relationship with them.
- Each small step of conversation upgrades the foundation for your relationship. Follow up and do kind actions for others to establish yourself in their memory.
- Being friendly, trustworthy, reliable and kind doesn’t need special knowledge.
- Have the courage to acknowledge your mistakes.
[35:52] Claire: ‘I do think good teams have a little bit of background context to each person.’
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[43:57] Managing Relationships and Influence
You can influence your colleagues and those in higher positions by getting to know each other better.
- Use your experience to help mentor your juniors.
- Your relationships with others can give you a more significant ability to influence changes.
- After you build trust, it’s easier to bring up problems and suggest solutions.
[46:12] Kit and Claire’s Top Three Tips for Managing Horizontally
- Kit recommends accepting that creating influence may be complex. Secondly, look internally and build your self-confidence.
- Build trust in a relationship to work effectively with your team.
- Claire’s advice is to be kind and build your connections.
- She also advises you to present possible solutions alongside the problem. Be prepared to take risks and step out of your comfort zone.
[48:01] Rachel’s Top Tips for Managing Upwards and Sideways
Rachel’s first tip is to work out what’s important to the person you are trying to influence.
- You can do this by listening and asking questions to build your relationships and trust.
- She also advises staying within your zone of power. Keep in mind that you are not able to control what others do.
- Open yourself to the ideas of your colleagues. Listen and consider what they have to say as well.
About Claire & Kit
Dr Claire Edwin is a National Medical Director’s Clinical Fellow of the National Health Service. Her clinical training included a 4-month post at a public health department which gave her insight into the determinants of health. Claire also underwent two years of surgical training before becoming a member of the Royal College of Surgeons. Currently, she aims to develop her skills upward by collaborating with those working with the Faculty of Medical Leadership and Management.
Want to connect with Claire? You can learn more about her on the Faculty of Medical Leadership and Management website and contact her on Twitter or through her email.
Dr Kit Muthuswamy is a National Medical Director’s Clinical Fellow of the National Health Service. With a background in radiology, she has learned firsthand how to manage upwards and sideways. Kit is currently working with the Faculty of Medical Leadership and Management alongside Claire.
If you want to connect with Kit, you can contact her on Twitter and through her email.
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I think you can think of influencing as a form of negotiation. And that can really help, especially when influencing upwards because actually, often it is that mental block of thinking about the person and what position they’re in. But actually, if you can think about the issue that you’re trying to influence on and why it’s important, then that’s more important than focusing on the person and worrying about what they might think of you.
Rachel Morris: Do you have a boss, or a team of partners, or colleagues, who you’re definitely not the boss of? Does getting everyone on the same page sometimes feel like herding cats? And do you wish you could just make them do what you need them to, but you’ve got no official authority? Everyone has a boss unless you’re the prime minister and even then, well. When I’m coaching doctors and other leaders, managing upwards and horizontally is one of the main issues people say they want to get better at, no matter where they sit in the hierarchy, from trainee to clinical director, and it’s something that we all struggle with.
So this week on the podcast, I’m joined by Dr Kit Muthuswamy and Dr Claire Edwin, two of the National Medical Directors clinical fellows, to discuss how we can effectively manage our bosses, our peers, and our team members, even if we feel like we’re at the bottom of the pecking order. Kit and Claire have noticed the big difference in how they are approaching people as clinical fellows. And we talked about the barriers that we all face, from trainee to CEO, when it comes to influencing without authority. There are so many ways to influence someone without resorting to hierarchy. In fact, if you have to do that, you’ve probably already lost the battle.
We discussed some useful strategies picked up from bitter experience, coaching, and helpful books, which will help us have greater impact and influence so that we can do our best in our assigned roles. So listen to this episode to find out why the biggest barrier to managing your boss might be in your head, how to find out what really motivates someone using the Five Currencies, and a simple framework for getting to a win-win situation.
Welcome to You Are Not A Frog, a podcast for doctors and busy professionals in healthcare and other high-stress jobs if you want to beat burnout and work happier. I’m Dr Rachel Morris, a former GP, now working as a coach, speaker and specialist in resilience at work. Like frogs in a pan of slowly boiling water, many of us have found that exhaustion and stress are slowly becoming the norm. But you are not a frog. You don’t have to choose between burning out or getting out.
In this podcast, I’ll be talking to friends, colleagues, and experts, all who have an interesting take on this and inviting you to make a deliberate choice about how you will live and work. Before we get to the episode, I wanted to mention that in June, we’re reopening the doors to the Resilient Team Academy, a membership for busy leaders in healthcare who want to support their teams for resilience, well-being and productivity without burning out themselves. We know that for many leaders, escalating workload and staff shortages mean that you and your team are feeling increasingly overwhelmed and one crisis away from not coping.
The Resilient Team Academy helps you to get a happy and thriving team by teaching you to use the Shapes Toolkit to support your colleagues, giving you all the resources you need, from monthly live webinars, which you can also catch up with on-demand, to bite-sized videos, short team resilience-building activities that are already done for you, and much more. And we already have several PCNs and training hubs, NHS Trusts and other healthcare organizations signed up. If you want to find out more about our special discounted packages for PCNs and other organizations, then to check out the link below in the show notes. Now on with the episode.
So it’s great to have with me on the podcast today Dr Kit Muthuswamy and Dr Claire Edwin and both of them are national medical directors’ clinical fellows. They’re working with the faculty of medical leadership and management. So welcome both of you, it’s great to have you here. Now in a previous life or in another life, Kit, you’re a radiology trainee, and Claire, you did some surgical training and then you are now actually hoping to be a GP trainee from August. So very much in the training process at the moment.
And Claire has been a guest on the podcast before when we had a panel discussion about learning from failure, haven’t we really enjoyed that discussion. And she’s brought along her colleague, Kit, to talk about the thorny issue of managing upwards. I think you initially said to me, Claire, that you really noticed the difference in how people treated you or possibly the way you reacted to people through being a national medical director’s clinical fellow compared to when you were a trainee in a hospital. Is that right?
Claire Edwin: Yes, I think that is right. I do think that having a sort of title behind me this year has changed the way I can speak to people and approach quite senior people that in a normal setting I would never have dared to approach. For example, I met Tim Ferris in the lift at work yesterday and introduced myself to him having seen him on a call and seen him speak up and lead a healthcare conference back in November. But I’m pretty sure that if it was 12 months before and I’d have seen someone like that, I wouldn’t have introduced myself
Rachel: Side note. I’m thinking this is a different Tim Ferris to the one I’m thinking of, not the Tim Ferris, The Four Hour Workweek and the massive podcast. is that it’s a different Tim Ferriss.
Claire: Tim Ferris, Director of Transformation for the NHS.
Rachel: Yes, I remember, I remember thinking that when I heard him at the conference, actually, he was very, very good. So it’s this sort of permission to, because of the title and what you’re doing, almost gives you permission to feel that you could just chat to him, right?
Claire: I think it has also given me a lot of confidence and this fellowship year does really build upon that and sort of developing yourself in a huge way. Particularly thinking forward, I will be going back into GP training is that ST I, and I know that that title won’t be behind me. So thinking about how to influence developing the skills that I’ve gained this year is something I’ve been thinking about.
Rachel: And Kit, what about you? Why is this topic sort of particularly close to your heart, because then when we’ve talked about it before, we all get really animated, as soon as we started talking about managing up was. And by managing upwards, we mean, managing your boss and more seniors, also managing your colleagues as well. So it’s a bit of managing horizontally too.
Kit Muthuswamy: Yeah, I think it’s a really important topic to talk about, especially as trainees in the NHS. I think the NHS is very hierarchical in the way it works. Having that hierarchy for clinical supervision is really important for patient safety, and as a trainee to feel reassured. But I think that kind of permeates through working culture, in general, in the NHS. And as a trainee, you’re very much made to feel your position as as just a trainee, and that you shouldn’t really speak out of place, or you don’t really have a role thinking about anything kind of outside the sphere of your direct clinical practice or your own peers.
And I think actually that’s quite sad, because trainees come from so many different backgrounds, and have so many different experiences amongst ourselves. And I think to actually not harness that and not to make the most of it, and not to encourage trainees to speak up and use their experience and diversity of thought to influence greater changes is such a shame. And I think that’s why it’s really important that we recognise that we do have a voice, that it’s a valid voice, and that we can use it to create really meaningful change.
Rachel: So it’s interesting, you’re talking about that from the trainee perspective. I see a lot of issues with this from the non-trainee perspective as well, because everybody’s got a boss. So whether you are qualified, whether you’re in your first five years of your chosen speciality or your chosen profession, whether you are the medical director in a hospital, you still have a boss. And I have had episodes when I’ve been coaching, somebody really quite senior in a hospital, who was really worried about how to manage the CEO, or even even “Am I able just to knock on the door and talk to the CEO?”
So I think we all feel this hierarchy, no matter who you are. And let’s face it in the NHS, and probably, in most other organisations, unless you are the very, very top and even then you’ve probably still got a boss or you’ve got your shareholders to answer to or whatever. You always have a boss. I think this is relevant across the spectrum. When I was teaching on the Red Whale Lead. Manage. Thrive! course, we did a section on managing upwards. And actually that was people reporting that was one of the most helpful sessions that there was because it’s really hard in general practice.
You do have to influence your partners because you don’t have that direct hierarchy over people, particularly when you’re working in a partnership, probably, there’s less of that ability to invoke hierarchy when you work in that partnership than there is maybe in a hospital department where you’ve got the lead and then everybody else underneath it. And then you’ve got the different tiers of trainees. So I think this is really, really relevant to lots and lots of people. So first of all, I was interested because it’s like, you guys have given yourself permission to speak up. And when we were talking earlier, you said that you thought there were internal barriers and external barriers. And I wonder if that’s thought about, “Well, I’m just a trainee, I’m just that” is one of the external barriers that you were talking about.
Kit: I think that’s definitely an external barrier. And I think once you start thinking like that—once you start letting that affect you thinking, “I’m only a trainee, and I don’t have influence”, or “I just don’t know how to go about talking to people in more senior positions”, or having that influence over people in more senior positions, I think it’s actually really hard to go out of your comfort zone, if you never have, if no one’s ever encouraged you, if you don’t have the self confidence, which is an internal factor, to push yourself and go and say something or do something, then I think it can be a very difficult one to overcome.
Rachel: So Is it all about internal self-confidence, do you think?
Claire: I think as a junior member of the team, so often you’re not there for as long or you might be moving around. So it’s harder to establish those relationships because you haven’t had that time. But I also think from an internal point of view, you kind of have to accept the risks that you might get batted down. And that, I suppose that’s about your internal resilience and sort of ability to overcome that. So I think there is a lot to be said about self-confidence and your development as a person, is it developing yourself in sort of order to be that team player and influence people around you?
Rachel: So there’s two things that are interesting to me, and the first one is developing yourself and how you come across. And I know I’ve told this story in the podcast, but I’m going to tell it again, one of my colleagues and the lead manager, was a graduate medicine program graduate, and before he became a doctor, he used to work full of the banks who used to head up their marketing departments who had had really senior roles had been used to leading a team, he ended graduate medicine. And when he qualified, he went to be a junior doctor on the ward. And we were sort of reminiscing about how it was, et cetera, et cetera. And, and then he said something really interesting. He said, “Oh, well, yeah, we had that problem. But I just went up to the consultant went, ‘Hey, Bill, what are we going to do about this then?’”
I thought, “Oh, I’ve never said that.” But it’s that internal confidence that he had of, actually, we’re just trying to sort this problem out, there’s no hierarchy here. We’re all on the same side, we’re all on the same team, which I think sometimes we don’t get. When we’re trainees we really see the hierarchy. And also, probably the way that he did it in the way that he presented himself probably meant that the consultant may be respected that a little bit more it may be because he was male and a certain age. There is that as well. There’s always that gender thing, we mustn’t forget about that. But I do sometimes think that we are our own worst enemy, when we really, really feel the hierarchy and fear, bringing stuff up because of the hierarchy.
Claire: I think as a junior, when you look young, you are young, you’ve gone straight through, you haven’t developed that life experience, but you’re working at the same level as some people that have done have had previous careers that’s actually quite hard to overcome.
Rachel: It’s interesting what you’re saying Claire, because obviously, we talk about that zone of power a lot. What’s in your control, what’s not in your control, and your age is out of your control, right. You don’t have any control about how old or young you are, what you can control is how you do things and your approach. And I remember when I was a very new GP, in one of my salary jobs. When something was bothering me, I would just go present myself to the practice manager sit down and whinge about it, but just be very whingey. And probably it was really annoying. And she probably had 20 Other people whinging at her that day as well.
And so that wasn’t really gonna get me anywhere, I couldn’t change my age. I couldn’t change my status or the hierarchy within the practice. But I really could have changed how I approached that. And I think this thing about managing upwards, managing horizontally, actually, there are a lot of things, we can change and we can do something about. We can’t do anything about the hierarchy. But I always say when we teach this, we have an influence without hierarchy training session, when we teach this to GP fellows and training programs and other people is that if you’re invoking hierarchy as the reason why something is a good idea, or things should be like this, then actually you pretty much lost the battle anyway.
Because you have to influence in lots and lots of other ways apart from the fact it’s my way or the highway because I said so. I think earlier today you talked about building trust within the relationship. From your experience, how can you build that trust so that you can go and influence a bit better?
Claire: I think a lot of your influence. It’s about your networks and your connections, and how you build trust between your colleagues, and within different levels of people above you, people working in different professions. I think it’s all about trust, demonstrating that you’re a reliable person, that you are hardworking and trustworthy. I think it’s also about being kind to people. So I think we, you know, the pandemic has really changed a lot of the narrative about well being. So asking someone, “how are you?”, actually asking your boss that is just the same as asking your peer or you’re someone more junior to you. And I think that’s actually a really powerful way of, of building those connections.
Rachel: That’s interesting, because we don’t often ask our bosses, how are you? How you doing? Are you okay? What’s going on in your life? And you know, these people are human beings as well, aren’t they? I mean, we’ve all been somebody’s boss, or somewhere in that hierarchical order and it’s really nice when people actually care for you. And this is just sort of reminding me that in, I guess, in almost everything we teach, prevention is so much better than cure, isn’t it? It’s much better to prevent burnout than it is to cure it. And with this influencing piece, it’s much better to build the relationship, have a good relationship based on kindness and respect. And then you can go and influence than wait if something goes wrong, have no basic relationship there, and then go and try and influence.
Claire: Yes, I actually had a recent conversation within some of our fellow colleagues, talking about interprofessional relationships within their organisations, exactly as you were saying, Rachel, speaking to your practice manager, where people have spoken to the operations manager of that particular department. And they’ve got hold of that number really soon in their job, and they just call them up and moan about whatever’s going wrong. But we discussed the merits of really actually putting yourself out there and introducing ourselves to those people and building that trust before you go with a problem. And I think that’s actually something I’ve definitely got wrong in the past. But thinking ahead to the future, that’s the kind of attitude I’d like to take forward.
Kit: It’s not just in terms of implementing on a particular matter, I think it would help with the overall workplace culture of everyone trusting each other and being open with each other. And I think if you’re expecting other people to kind of be open with you and share their issues with you, I think you have to be willing to do the same. I think that’s really fundamental to having a good workplace where you can share your thoughts, not feel intimidated by someone just because of their position, and know that you can talk to each other and help each other when needed.
Rachel: I love that suggestion of actually going in introducing yourself. I mean, we really bad, at least in the NHS, there’s been this movement of “Hello, my name is” and so we’re much better introducing ourselves to patients. But often, `teams don’t introduce themselves to each other, do they? Or someone’s wondering, and you sort of know who they are? Or you think you do to actually say, “Oh, hi, I’m so and so I’m the new whatever, please let me know, if there are any issues here or there. And if I can assist in any way”, “I’d love to do that”, et cetera, et cetera? Or “Can I pick your brains about something” and you build the relationships.
So it’s introducing yourself just getting to know people is a really good tip. What other really practical strategies, have you guys either learned about or experienced while you’ve been clinical fellows or have a read about that you would suggest to people?
Kit: I recently read a book, which you recommended, actually, Rachel in one of our previous chats, and it was Getting to Yes, and it’s about the idea of using principles rather than positional negotiation. So rather than thinking of kind of a hard or soft negotiation, where you’re thinking about your position and not yielding your position, thinking about the problem, rather than the person that you’re negotiating with. And focusing on interest, and how you can gain mutually from something, rather than thinking, “I need to achieve this and if I don’t achieve this, I’m not I’m not going to give in until I do this.”
And I think that was really interesting because I think you can think of influencing as a form of negotiation. And that can really help especially when influencing upwards, because actually often it is that mental block of thinking about the person and what position they’re in. But actually, if you can think about the issue that you’re trying to influence and why it’s important than that, and that’s more important than focusing on the person and worrying about what they might think of you.
Similarly, I think if you start thinking about your objectives, and how both sides can benefit and if you’re kind of meeting a shared interest. Again, I think it just helps with that self-confidence that you might have approaching a situation because you think, actually, they have something to gain this is something that they want as well. So approaching that I think you feel a lot better than thinking “I’m going to try and achieve something for myself or something that I want to do.”
Rachel: I love the book, Getting to Yes, it’s helped me no end. And I think you’re absolutely right. I think that influencing is one end of the scale, maybe it’s like a one or two, and then you’ve got negotiation, we might get to a five or six, and then you’ve got conflict where you’re a sort of eight or nine in terms of emotional intensity. But it’s all absolutely the same thing and I do find those four principles in that book really helpful. The first one, separate the person from the problem by literally, rather than saying “You have made a really bad rota, and you’ve been really unfair”, it’s actually “Can I chat to you this, we’ve got a problem that the rota is looking a bit tricky here. Can we talk to you, can we chat about it, and any way we can do it?”
So it just, it’s always triggering the person for a start. It avoids the old defensiveness and yet, I can actually then focus on the problem I remember. And again, I think I’ve told this story before, I was coaching a GP practice and one of the issues was, we don’t know when this person is going to retire. And it’s really difficult for the whole practice, because we don’t know when they’re going to retire, and we can’t possibly talk about it. And it’s all about this person being really difficult. And we looked at how to separate the person from the problem.
Actually, the problem was, if one person retires, or get sick, or goes under a bus, this practice is in problem. So the problem was succession planning and recruitment. It wasn’t all about that person and as soon as they could see that they could work on the problem together. And it wasn’t us against them anymore. And that was really, really helpful.
Claire: I think it’s probably a bit unfair to blame someone for wanting to retire.
Rachel: Well, they weren’t blaming from wanting to retire, they were blaming them for not knowing when they were going to retire. So it was the whole, it’s really unreasonable for this person not to let us know. So the problem was completely mixed up, even though legally the person didn’t need to tell them. They were feeling the uncertainty. So the problem wasn’t the person the problem was, there is uncertainty in the future about our workforce planning, does that make sense?
And so once you can work with it was much, much easier. So separating the person from the problem. I think the next step is working out what somebody’s interests and needs are versus their position, and I found this incredibly helpful. So that the idea that you don’t just look at what the position of someone is. Like, I want to make sure I am not working this day in the rota and rotas are a universal problem whether you’re in a GP surgery, looking at your annual leave, or looking at the on-call rota or as a trainee or as a consultant, or whatever. You’ve got this position, “I want this”, and other people, “I don’t want this”. So the positions are completely opposed, then if you look deeper at the interests.
So in the book, they talk about the position is what you say you want, under your interests are, why I say I want that. So you know, why is it that I’m saying, “I can’t ever be on call on a Thursday”. It might be that I’ve just got to pick up my child and I don’t have any childcare? Well, there’s something going on at home, it’s really important to me. So my interests are to actually be able to look after my family properly. And then, underneath that, you’ve got your needs, like what must I have? I must have a happy, safe home environment, as well as a happy work environment. And once you start looking at the deeper interests and needs, you’ll find that actually people are much more aligned, rather than on different sides of the argument.
I guess, at a macro level, you can think about the whole of the NHS, because actually what we want is good patient care, good safe patient care, right? And people to have better outcomes, yet, everyone’s fighting with their different positions about this, we need this, and then I need this resource. Actually, overall, the resources come from the same pool, right? So that’s a really, really macro issue. But I guess you can see this played out in departments, as well.
Claire: I think a key point is within the NHS, that interest should always be the patient and we do very often lose that. The reason we’re all here and the reason we all stay and do our job and help people is putting patients at the centre of it. You see that when you’re stressed and when you’re looking after patients that are unwell, you can see there are different conflicts. I kind of have a broad story where I had a conflict with a senior consultant at A&E.
I didn’t refer to the patient and then my consultant told me I really shouldn’t have accepted that patient but I didn’t really feel like I was able to say “Hang on, I just need to speak to my boss. I’m not really fully sure about this one.” And then ultimately, I was left with this patient that really needed to be looked after another speciality and then eventually got quite confrontational in the middle of the A&E shop floor and I felt quite upset. But eventually, the consultant kind of said, “Well, what do you want?” I was like, “I need your help.”
And things were very different after that. And at the end of the shift, he actually saw me and said,” Look, I’m really sorry, I was really stressed”, and apologised. And I’m pretty sure I kind of apologised too and said, “Yeah, I was really stressed, too.” That was just a really difficult situation that I had not been in before. And I guess putting the patient at the centre of that would have been really helpful because I was not the best person or speciality to be looking after that person.
Rachel: I think there are two things about that. The first thing is, I would say hats off to that consult for actually saying, “What do you want?” Because that’s when you start to dig into that other person’s interests and needs. We’ve got these positions, but deep down, what would youn like? What do you want? Do you want this rota to be changed? What is it that you want? So however you did it, good question might have been inactive, slightly wrong. But secondly, I have got a bit of a “yes, but” there, Claire, because I do think this thing about patients can be used as a stick to force people to do stuff. “Oh, it’s for the good of the patient. Okay, so I’ll sacrifice my family, my weekends, my everything like that.” So yes, I think patient needs and looking at a patient and getting good health outcomes, absolutely.
And we all should quite rightly have that as an outcome. However, also, having happy, engaged staff is a good way to have good patient outcomes. So I think looking at the interests of actually in this department, we all want to work together, we want to be happy, we want to feel safe with each other. So how can we get to that? Everybody, everybody wants that deep down, they want to have good relationships, so you can start to dig into the interests and needs and in that way, as well. And interestingly, the example you gave,”What do you want?” “Well, I want to feel supported in my job, I want some help with this patient. And I want them to be with the right speciality.”
Which I’m sure you want them to be with the right speciality as well, even though our positions are, I won’t say them and nor will I type thing. Actually, we want what’s best for the patient. And also, we want the the right person to be looking after them. So we all feel like we’re doing a good job. That makes sense.
Claire: Yeah, I do completely agree. Early this week, we had a conversation about the future of general practice, and talking about preventing burnout, and how you build those kinds of teams. And actually, a lot that came through was discussing the importance of that balance and actually to make the job sustainable, you really do need that balance and support and resilient workplace that isn’t just kind of drawing on your empty reserves all of the time. Because that really doesn’t work and it doesn’t do good for patients or the staff.
Rachel: There’s a book that I go on about quite a lot called Influence without Authority, which is what I base a lot of our work on by Cohen and Bradford. Which gives a really useful model, or actually, it’s more a set of principles really for how to influence and where it’s getting to, yes, talks about positions, interests and needs. This book talks about the Five Currencies. And I think that one of the key things about influencing people and managing upwards is actually understanding what makes them tick and what’s important to them.
So I remember, again, team coaching and practice once, and the practice manager was sort of tearing out her hair because they needed a particular member of staff and no matter how many times she’d asked the partners, they just wouldn’t sign it off. And none of them had any particular reasons why but she was just tearing her hair, and we had a one to one coaching session. And she’d been going to the partner saying, “Look, the rest of the staff are really tired. They just can’t cope with this workload. We’ve got to recruit this other member of staff.” And of course, you know, a really busy GP hearing that probably gets out this really tiny violin and goes, “Well, we’re all really busy. We just need to handle it.”
First of all, to this particular partner, the one that signed it off, what did they really care about? She said, “Well, they really care about doing a good job, getting really good QOF results, and maintaining the practice income.” So simple. What will happen if you don’t get this other member of staff? She said, “Well, actually our incomes going to fall because we’re not going to meet this particular target because we’re too short staffed.” I said, “So have you mentioned that to them?” “Oh, no, I haven’t yet.” So she then went along next time and spoke to them about the issues with the QOF and meeting the targets and the income of the member staff signed off straightaway.
So it’s not just it’s not to illustrate any other point apart from the fact of understanding what people’s currencies are. So in the Influence Without Authority book, they talk about the five different currencies, one of which being inspiration. So some people are motivated by their values instead of the cause. Some people are motivated by the task like getting it done, by the money by getting the right resources by expertise, they’re very task-related staff. Some people are really motivated by position, recognition and reputation and visibility. So if you’ve got someone who’s a bit reluctant to actually you know that it would give them good reputation, good visibility, then actually talking to them about that might influence them.
This is not about manipulating this is about influencing them to do something good. The other currencies is relationships. So interpersonal relationships. So if you ask somebody to do something that they think is going to really disrupt an interpersonal relationship, it’s going to be very hard to influence him to do that. Some people don’t really care about that. But people that have that relationship currency, really think about their networks and bonding, and they’re very affiliative. And then finally, some people, you’ve got this personal currency, which is freedom, and autonomy, and all those sorts of things. So people are very, very different. And I think one of the mistakes we make is assuming that another person is going to be motivated and influenced by the same thing that we are.
Kit: I think it’s really easy to make those assumptions because you know what you’re motivated by, and it’s very easy to assume that that’s the case for everyone else, because in your mind, that’s the truth. If you’re motivated by positions of power, you automatically think that’s what everyone’s aiming towards. But of course, that’s not the case. And I think that just really highlights how important it is to be open with each other. And I think actually the first part in expecting to know about what someone else’s motivations are, or what they’re seeking, what might drive them to say yes to something is actually kind of maybe sharing what your motivations are with them.
And I think if you’re open, and you’re happy to share what your position is as well—I think position is the wrong word, but your motivations are, I think that encourages that dialogue. And I think going back to the kind of clinical example, especially in radiology, I think often radiologists are often the stereotype is that is that we say no to everything, especially on calls, after hours. Sometimes there’s something in having an open conversation with the person at the other end of the phone and explaining why you might say no to something, because actually, all they hear otherwise, is the fact that you’re saying no, and that just makes them angry and annoyed and think that you’re being completely unreasonable. But actually, there might be a very good reason, for example, it might be better to do something during working hours, rather than in the middle of the night, when there’s no one else around to support you.
If you share what’s on your mind and what’s motivating you to say something and suggest something else, then they might be more willing to share where they’re coming from, as well. And I think there’s more likelihood of you reaching a shared joint decision that you’re happy with, rather than both parties leaving feeling unsatisfied with the situation.
Rachel: I love that. It’s all about, sharing your thought processes and what you’re going through. It’s interesting with the Cohen-Bradford influence model in the influence without authority book, because actually I used to think that to influence upwards—to manage upwards managed by colleagues, it’s all about what I said and dead. Actually, what I what came out of my mouth, it’s not actually it’s much more about your mindset, and listening. So there’s six different steps. The first one is assume you’re on the same side. So that’s really nice. So you’re not against each other, you’re actually wanting the best. It’s like, we want the best for patients, we want the best for staff here, knowing what matters to them, what’s really important to them.
And to find out, I don’t think you can do anything but a get to know them and be less than or ask away in a second. I’m going to ask you guys how as trainees, you feel you could ask your bosses about what’s important to them, or how you could find out another step is understanding their world. So it’s like what you said earlier, the person you’re trying to influence probably got a million different things going on that you don’t know about. And so just a bit of context about what they’re dealing with. And then you’ve got to your stuff, really. So A choosing your approach to this. Going in a very combative way, or just going in and whinging very rarely gets you what you want, as I have discovered on several occasions, but also, actually knowing what you want.
So one of the big problems in influencing negotiation and I did a negotiation course once, and if you don’t go in knowing actually what would be a good outcome for you and knowing what you’re trying to achieve. But actually, you just flip flop all over the place. And everything’s a bit unsatisfactory. It’s much easier when you can go “look, I’ve got this I’d love to discuss it. What I’d really like to happen is this but obviously open to anything suggestions, what do you think?” And then you can choose your approach and that’s when it does become about you. How am I going to do this? And then the final step is focusing on a win-win solution, i.e. one that’s that’s okay for everybody. See if you get that rota and someone’s going, “I won’t do this” and other person going well, “I won’t do this” — actually, is there a compromise? Okay, well, I would be happy to do this, on this day if perhaps I could do this on another day, and how can we get a win-win situation? That’s maybe not even on the table.
So in all of that, as a trainer, how would you find out what matters to people? How would you find out what, what’s in their world, and what’s really, really important,
Claire: I think that’s the importance of making those connections that I mentioned previously. So that kind of building trust and getting to know each other, there’s always a fine line, that I’m not quite sure where it lies. And some people obviously have a different line in terms of being nosy versus being interested in someone. But I do think good teams have a little bit of background context to each person. So for example, Kit and I were in a team meeting yesterday, and we all went around the room, that’s a new member of the team. And instead of talking about people’s priorities for the week, we talked about favourite books, favourite films, or TV series, and different people recommended different podcasts. That kind of gives a real insight into people’s common interests. But also, just kind of understanding how people live their lives a bit, I think that’s really important.
I really like to know, sort of a little bit of context to a person to get to know them. And I think in terms of that influencing and what you’re saying in terms of your currency, I think that’s really crucial.
Kit: One thing that I’ve really learnt in my time in this fellowship, so far, is that if you want to find out more about someone or you want to talk to someone, actually, it’s okay, just to ask them to approach them and say, Would you be able to spend kind of half an hour with me just having a chat about what you do, I’m really interested. And often, if they’re able to recognize that you’re coming from a place of genuine interest, they would be open to having those conversations. And I think often the problem is building up that courage to go and ask in the first place and I think this year has definitely helped with that because there has definitely been more of a culture of people saying, feel free to come and put some time in my diary, and we can have a chat.
And I think that’s gotten me used to the idea that that is something that I can do to sometimes push yourself outside of your comfort zone a little bit. Because I think it’s very easy to stick to what you’ve always done and, and not have those conversations or not approach those people who you think might be more senior and might not be wanting to talk to you. But actually, I think sometimes if you do push yourself out of your comfort zone and make a little step towards talking to someone, maybe it’s just an email, or maybe it’s a conversation in the corridor when you see them, or just introducing yourself, as Claire said before. I think it’s those small steps that then build a foundation for you to take the next step and have a more in-depth conversation or actually then take an idea to them. So I think that’s also really important and something that I will take forward.
Rachel: It’s about building that relational capital, isn’t it? And in my experience, people very rarely turn you down. If you say, “Look, can I buy a cup of coffee, and pick your brains about your job and what you do and how it all works.” And then when you get that half an hour, people love to talk about themselves and talk about their jobs, because actually, they don’t get to do that very much. Particularly if you are the boss is quite lonely at the top. And often you don’t have people to talk to. Now they’re not going to bear their souls to you. But if you start to ask questions like, you know, what’s the most challenging part of your job? Where are the real issues that you wish you could solve? And the more questions— insightful questions you ask, honestly, sidenote, and quick hints, coaching is brilliant coaching questions are brilliant, because people come up with their own answers, and then attribute the wisdom to you.
So they’ll be like, “Wow, you know, that Kit, she just was asking such interesting questions.” And when she said that she was bang on, like, you might not have said anything, but they’re attributing this. So what’s the stop you just going to find out? And often, you’ll find some absolute nuggets. And then when you see them again, you can ask them “How it’s going? How’s it gone with that thing? Was it okay? How’s your cats?” Even little things, if you remember things about people, and follow up and ask them people are ever so touched, and that is all building up the relational capital.
And there’s also things like reciprocity if you are trustworthy if you do people favours if you get out the way to help them, etcetera, they will remember that, and then that’s a really great way to influence as well. Again, this is not trying to be manipulative, it’s just being a normal human being. And it’s interesting, I’d be interested in your thoughts on this. I saw a little video either on Twitter or Facebook, a while ago, and it was for new graduates. And it was how to get on in the workplace. If it was from some boss, who was obviously completely hacked off with a bunch of new graduates, it was: turn up on time, wear reasonable decent clothes, make sure you have a wash, don’t take over long lunch breaks, don’t be hungover, when you come to work, be pleasant and polite, say please and thank you, do what you’re asked to do, and be friendly.
And at the end of this video, she said, you know what, none of that requires any sort of knowledge or skill. So, even if you’re really rubbish at your job, I mean, you’ve got to be good at your job, that does help build trust, actually, even if you don’t have the knowledge or the skill, or you’re starting somewhere new, and you don’t know anything about it. If you are just friendly and polite, and you turn up on time, and you do what people ask you to or you do what you say you’re going to do. That actually builds a lot of trust in a relational capsule. Now, I don’t know if you agree with me or not.
Kit: I completely agree with that. I think there’s so much to be said about just being a nice person. We’ve spoken about building those relationships and connections. And that’s all based on trust. And I think obviously, having the competence in whatever you’re doing is one aspect of it. But it’s such a big aspect is just, it’s just being a nice person being honest, being reliable, having some integrity, and I think that counts for so much.
Claire: I also think you know that you’re always polite, and you do your best. But it’s also about acknowledging when you’ve maybe not had the peak moment where you’ve not done your best and you’ve been a bit snappy or you’re hungry, or you’re really stressed. But it’s about having that bravery to go to someone and say, “Look, I’m really sorry, I spoke to you like that. An hour ago, 10 minutes ago, yesterday, I was really hungry.” Just apologize, just—or something like a gesture depends on how you kind of demonstrate that. But I think sometimes it’s important to acknowledge where you’ve not been at your best. So I think that gets you a lot of credibility to that. But that takes quite a lot of bravery. And I suppose it’s a bit about risk-taking. And, like I mentioned earlier, being a bit out of your comfort zone because it’s not easy to acknowledge where you’ve not been nice and perfect.
Rachel: No, but it happens to salt doesn’t it? None of us ever, totally 100% behave the way we want to. It’s also that admitting when you’ve made mistakes as well. There’s nothing that winds me up more than someone making mistake, not admitting to it. Me finding out about it, and then having to sit it just makes me feel really annoyed. Whereas if someone had made a mistake, they find out their consumer said, “I’m really sorry, Rachel, this happened. And this is what I’m going to do to put it right.” I’m like, “Brilliant, thank you so much.” That actually builds more trust with me than someone who does everything totally, perfectly the first time because actually, nobody does everything totally, perfectly the whole time.
So if you’re not admitting when you’ve made mistakes, or that you don’t know something, that’s another thing. Not admitting when you’re not sure you don’t know something that is—that really undermines trust from I think a boss, to people they work with. So I think that’s a really useful point to raise Claire. And I’ve got time has gone really quick, hasn’t it? We’re nearly the end of the podcast in a minute, I’m going to ask you for your three top tips. But before we do that, Claire, I just wanted to pick up on something I think we talked about earlier because I think in order to influence, in order to build up trust, there’s a degree of proactivity needed not just hiding under the I’m a trainee, or I’m I’m lowest in the hierarchy, even when you’re fully qualified “I’m not the Clinical Director”, “I can’t —.”
There’s a productivity that’s needed to go and have those conversations and then when you go and have those conversations, don’t do what I did. And just sit down and whinge and not go with any solutions, because that will also really wind people up. So what would you do instead of doing that?
Claire: I think we mentioned earlier how you influence and whether that’s influencing your peers and colleagues influencing your seniors or even influencing on a bigger level. And I think influencing your peers and your colleagues, that horizontal influence that we’ve mentioned, is sort of getting to know each other that coffee break culture, sitting down buying someone a cup of tea, or offering the biscuit or whatever that is. I think that’s really important. If you’re working with junior colleagues that are slightly more junior than you, then use some of your experience to kind of mentor and share good things and bad things that have happened and things that have worked well not so well. I think that gains trust and respect from them. And you can be a role model.
And then I think when you do have a problem as a junior team, then you kind of built that trust within that relationship to go to your senior and say, “Look, we’ve spoken as a group and we think this is an issue. We’ve come up with some ideas of how we think we could change things.” I think your seniors have been much more impressed and likely to be receptive to those changes if you present them with a solution, not just as a problem. And then I think there’s a lot of power in terms of building those relationships on a bigger scale. So I think as junior members of any part of society or organization, it feels like you don’t have a lot of influence and power, but actually, it’s kind of that collective influence that you can build.
So it’s all about building connections, people that have mutual interests. For example, one of the things we’ve done as a fellow group is set up a series of discussions and consultations with early-career GPs and GP trainees about the future of the general practice. Already, we’ve kind of got some really interesting buy-in from different organizations, because it’s a space that isn’t being filled when big decisions are being made about the future of the way we work. And the way that’s worked is people working very hard and putting a lot of effort and time into it. It’s about building those connections and networks to influence on a much bigger scale.
Rachel: Wow, we’re out of time, really. So I’m going to ask you for your three top tips. Kit, come to you what are your three top tips for managing upwards or horizontally?
Kit: I think my first tip is to acknowledge that it can be difficult sometimes, and don’t beat yourself too much about it. If you are finding a situation difficult. The second tip would probably be: look internally at yourself, and your self-confidence and your belief in yourself that you’re setting out to do the right thing for a cause that you believe in, and have that kind of belief in yourself. And the third would be, kind of very much what we’ve discussed, look externally at the relationships that you’re building with the people that you’re trying to influence, especially focusing on building that trust, so that you can work effectively with them.
Rachel: Thank you. And it’s interesting, what you said about looking internally, sort of builds up your confidence that I do lots of coaching with lots of senior leaders. And almost always one of their objectives is to be able to manage up with so even people that are really senior struggle with this and struggle with the confidence. So it’s a universal thing and so don’t beat yourself up about this, if you’re struggling, but it’s a really good skill to gain at any point. What about you, Claire?
Claire: So I think, number one is the kind, try and build those connections. Second, would be present solutions, not just problems. And thirdly, I think we need to be prepared to take risks and put yourself out of the comfort zone in the stretch zone. And I think that’s when you’re more likely to get better results and an influence.
Rachel: Thank you—amazing tips. I’ve just been jotting a few things down as we’ve been speaking as well, I think my top tips would be number one, work out what’s really important to that person you’re trying to influence. Because with the best will in the world if they have KPIs or they have targets they need to meet. And you’re talking about something completely unrelated, or that might even work against those targets, they aren’t going to agree to it. So you need to work out what’s important to that person and that means listening and asking questions. And the more you listen and you ask questions, the more relational currency, you will build up with them, the more you’ll get some trust.
And conversely, if you’re gonna just go around whinging and behaving really badly, then don’t expect to be able to influence people very well, because they will remember the way you behaved. And then I was finally I would say, stay in your zone of power. So a lot of coaches that I work with are like, “Well, if only I can influence them to do this or that” and, and often it’s stuff that they really have no influence over. And as we know, we cannot control what other people do, we can influence with our conversations and things. But the end of the day, a lot of stuff is out of our hands, we have no control. And so stay in your zone of power. Look at what you can control, and try and accept those things that you can’t.
And then finally, I just wanted to say a word to all those bosses out there, because actually, most people are also having to manage up with an manage, I don’t like the word manage downwards, but manage people who work with you or for you: we need to realize that and I think you said this, right at the beginning, that trainees and more junior people bring a whole diversity of ideas and experiences and probably have some really good ideas about different ways of doing things. Particularly if they’re from different generation, different culture, all those sorts of things that it’s really helpful to listen to people and take on their ideas.
And I think just everybody, treat your boss like a human being because they really, they really are. They have hopes, fears, dreams, worries, and anxieties, just like anyone else. And if you can be a listening ear and build up a good relationship, then that is going to stand you in really good stead. Thanks. That was really helpful. And, yeah, it’s made me think about a lot of things. So, guys, if people need to contact you, how could they get ahold of you or read anything further about this? What would you recommend?
Kit: I’m very happy to be contacted on Twitter or email and the links will be in the show notes.
Claire: Second, you can contact me by email or via Twitter too
Rachel: Fantastic. We’ll put that in the show notes and the bits we’ve been talking about Getting to Yes. And also Influence Without Authority. So I’d recommend anyone who’s interested in this to read those Getting to Yes, it’s a really quick easy read, so it’s been really helpful. So thank you so much for spending the time to be here. And we’ll have to get you guys back on to talk about more stuff because I think this is a really fascinating topic. So thank you.
Claire: Thank you so much, Rachel.
Rachel: Thanks for listening. Don’t forget, we provide a self-coaching CPD workbook for every episode. You can sign up for it via the link in the show notes. And if this episode was helpful, then please share it with a friend. Get in touch with any comments or suggestions at email@example.com I love to hear from you. And finally, if you’re enjoying the podcast, please rate it and leave a review wherever you’re listening. It really helps. Bye for now.
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Getting to Yes: Negotiating Agreement Without Giving In by Roger Fisher, William Ury, Bruce Patton
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