Module 2

Module 2

Introduction

As we learned in Module 1, in healthcare we are constantly communicating. This module will discuss public speaking, training others, and the importance of collaboration.

Module 2 is comprised of three sections:

1. Public Speaking
2. Training Others
3. Collaboration

Section 1: Public Speaking

There is a myth that public speaking is our greatest fear. Although not the greatest fear, public speaking normally makes a person’s top 10 list of things to avoid. Many people would rather sit in a dentist chair as opposed to speaking in public.

Studies suggest that the anxiety of public speaking stems from the level to which a person believes that he or she will be judged. And, unfortunately, audiences are doing just that – they are judging. Although we may not be consciously aware, we are also judging those who are speaking. We assess their posture, pitch, tone, audience engagement level, and within 20 seconds determine if we are going to listen or not.

Twenty Seconds!!!!

That’s how long we have to win over our audience and develop rapport. The good speakers will try and hold your attention within that time frame. The truly great speakers will have you hooked and waiting for more. Practice makes perfect and this is also the case with public speaking. The more you do it, the better you will become.

The following tips will help increase your confidence as you develop this skill.

1. Preparation. You are attending a regional healthcare conference and as you enter the auditorium, you recognize some colleagues and head their way. You sit down next to them and ask, “who’s speaking?” – they reply “you.” Probably not going to happen but imagine how nervous you would be if you were completely unprepared. Prepared speakers are better able to connect with their audience in that critical 20-second window. Prepared speakers are more at ease and can change their tone, pace, or even add levity in response to the audience. Unprepared speakers keep their heads down and stay glued to their notes. They are monotone and speak incredibly fast. We have all experienced this type of speaker and our daydream of Hawaii whisks us away until the glorious moment when we realize they are finished. Don’t be that speaker.
2. Know your audience. It is important that as we prepare our speech, we keep in mind our target audience. Who will be listening to us? What do they have in common? Why are they attending? Our presentation to a group of students would be much different than one intended for licensed physicians. Most professions have a shared lexicon. Lexicon is the branch of language used within a field. Have you ever tried to read the legal terms in a contract or tried to understand the fine print in a medication sheet from the pharmacy? While it may be uneasy for us to read, lawyers and pharmacists read the aforementioned with ease. We choose our words and concepts based on who will be attending.
3. Conquer your fear. Stress is greatest in the first few minutes of talking. Don’t be afraid to have a glass of water handy. Before you begin speaking, take a quick sip and after the first words come easily out of your mouth, you will be surprised to see how it gets easier as you go.
4. Rehearse. The more knowledgeable you are with the material, the easier it will be to find your confidence. Many speakers will grab family and friends and practice with them. They ask them to monitor for pace, pitch, posture, and flow. Good speakers learn the material well enough that they do not have to rely heavily on notes. How many of us have listened to a speaker when s/he has lost their place in the notes? Back to daydream Hawaii we go….
5. Be early. One of the best ways to avoid becoming too stressed while public speaking is to arrive early. By being early, you can meet many of the audience members and deescalate the fear of speaking to ‘strangers.’ Building rapport with your audience early also allows you to read them easier when you are standing in front of them.
6. Slow down and manage the time. When we are nervous or excited, we speak fast. Some of the best speeches are lost due to the speaker moving too fast through the material. Everyone needs a little time to process the information given. If it is new material that you are presenting, you will want to move much slower and provide natural pauses to allow the audience to mentally keep up. This is where reading your audience is so extremely critical. If you see the ‘deer in the headlight’ look starting to enter faces, slow down, or even take a quick break. Great speakers will allow the audience time to absorb and process before moving on. Lastly, good speakers monitor the time and will pace accordingly. In a recent study using the same speech, researchers found that a speaker who states that they have run out of time is ranked far less satisfactorily than a speaker who simply wraps up. Audiences do not like a speaker who cannot manage the time effectively.
7. Use humor. The final tip to help you become a skilled public speaker is the use of humor. Laughing provides natural breaks as mentioned above and helps both you and the audience relax. The cautionary tale though is to make sure that you address humor with proper speed control. Talking too fast will lose the joke and have the opposite effect – people will tense up and feel anxious for you. Humor also builds trust. If you can make them laugh, you can keep them fully engaged. In the same speech study as mentioned above, humor greatly increased overall satisfaction even with those who “lost” track of time.

In summary, it is completely normal to feel anxious about public speaking. After time, and this may sound hard to believe, many people eventually enjoy speaking in front of others. There is a certain amount of energy that can be had from the crowd. Just remember, great speakers were once just as nervous as you.

Section 2: Training Others

Introduction – The Adult as a Learner

Before we jump into the notion of training others, we must first develop an understanding of the adult learner. The adult as a learner is much different than your typical secondary school system student who devotes a large chunk of their day attending a face-to-face classroom. The adult learner can be subdivided into two groups: the learner who has returned to college for advanced learning or the adult who is learning skills related to their occupation. This section of our course will focus on the latter.

Where pedagogy is the teaching approach we take with children, andragogy is the teaching method used to help adults learn. Andragogy, which we will discuss here, understands that the tools and techniques used for teaching teenagers, would not be the same that we use for adults.

Take for instance this example. You have a 5-year-old and an 80-year-old. You ask them both to tell you about cats. The child instantly lights up and immediately begins to tell you about their experiences they have had with cats. Perhaps they have one or a family member has one. Their mental file folder, if you will, related to cats is small and readily accessed. They have what is referred to as fluid intelligence.

Now, imagine that you ask the 80-year-old to tell you about cats. The 80-year-old would more than likely pause for a bit as they accessed their numerous mental file folders related to cats. Perhaps they owned quite a few or they know that cats are the reference given to many large based species such as tigers, or lions. They also would consider the social situation in which they are present. They would analyze what the context of cats is in the current situation and then try and match the wealth of information they have access to in order to formulate an intelligent response to your question.

In other words, the older adult has far more experiences and information to sift through than our 5-year-old. The older adult has what is referred to as concrete intelligence. Unfortunately, most individuals do not realize the differences in sheer mental file folders and they incorrectly label the older adult as “slow.” When in reality, their brain is simply processing far more data points.

As instructors or trainers, we must understand that the adults we are presenting to have vast amounts of experiences from which to draw and we need to allow them the necessary time to retrieve and process our requests.

One of the key differences between andragogy and pedagogy is the concept of time relevance. Think of the time when you were a student in middle-school or high-school, and you were learning an abstract topic. You probably asked yourself ‘when am I ever going to need this?’ It is a valid question as much of the learning throughout school is future based.

However, as an adult, we will not learn something unless it relates to us in the present. In other words, if it is currently relevant to us and we have been explained how it will immediately help us in our profession, we will take the time and learn the material.

Let us dissect that last sentence. It mentions that we have had the need for the training explained to us. At this point in the course, let’s take a moment to review the critical importance of WIFM.

Most of our daily actions and motivations revolve around the WIFM acronym. It is not a selfish trait by itself but rather is the center of most of our motivation. I will do this because I know I will get that in return. It is the basis of the transactional theory of management where we believe that the employees will give us work in return for remuneration in the form of a paycheck.

As a trainer, we need to know the full WIFM scenario of the information we are presenting. If we don’t, the likelihood that our audience will absorb anything is slim to none.

The Training Session

This section of the course is big enough to subdivide into three areas: before presenting, while presenting, and after presenting.

Before Presenting

Before we begin the training session, we must completely understand our audience.

Here are some questions that need to be answered so that we can be ready for the actual training.

• Who is attending?
  • What are their roles?
  • How long have they been here?

It is important to know who is attending so that we can prepare enough materials for everyone. Have you ever attended a training session only to not have enough handouts? Also, it will be critical to know how many are attending to ensure we have enough space. Will we need additional room for breakout sessions? Etc.

• When will they be expected to demonstrate competency in the training?

Is the information learned in this session to be immediately applied in their position or is this an introductory overview? As you can imagine the depth of presentation for something they need to apply tomorrow will be much different than the presentation of something that will be required in 3 months.

• Is this new information that they are learning or is it a reinforcement of previous knowledge?

New information will require a much deeper dive into the material than a reinforcement or reminder type of training.

• Is their attendance mandatory or voluntary?

This is important simply because of the learner’s attitude. The level of engagement from someone who wants to be there as opposed to someone who must be there is much different. One negative Nelly can impact the entire training session for everyone involved. Being prepared for them in advance is key.

• As a trainer, do you know the information at an expert level or a presenter level?

Are YOU prepared to explain this on an operating level or are you simply the medium used by the organization to introduce the material to others? Are you prepared to answer in-depth questions or if not, do you know to whom to refer individuals with technical questions?

• Will you be asking the attendees to complete pre-work?

Depending on the amount of material to be covered, you may ask the attendees to complete some pre-work. Perhaps there is some reading material that would be beneficial to review before meeting together as a group? If there is pre-work, you need to best determine how much and when to assign it.

• Will you be using technology or require supplies to conduct the training session?

Before you present the information, it is wise to conduct a dry run to ensure that you have everything you need. Nothing worse than a presenter who experiences technical difficulty and cannot get the material to “load” properly.

Tip: Always have a back-up plan just in case the technology misfires on training day.

• Is the training session in a familiar or unfamiliar area?

If it is in a familiar area for attendees, no additional work is needed. However, if this is a new place, such as a rented conference area, will you need signs to make sure people arrive in the correct spot? What about parking? Validation?

All of these questions need to be addressed BEFORE the training session.

While Presenting

It’s training day! Nothing more exhilarating than being in front of a group of people sharing your knowledge with them.

On the day of training, be sure to arrive at the area well in advance of your first attendees. Power up the electronics and make sure that everything is in working order. Adjust the thermostat and set it just a little cooler than normal room temperature. Learning new information is intense and body heat is a bit higher. As a result, you will be surprised at just how quickly the room can heat up and be uncomfortable. Additionally, if employees bring laptops, there is that much additional heat being added. Lastly, warm air makes us all a little sleepy. But – at the same time, don’t freeze them! Just a bit cooler than normal.

Always establish an agenda and make sure that it is shared with the attendees. Experts suggest posting the agenda in a readily accessible place and to distribute the agenda to attendees.

Here is a sample agenda of a training session related to protecting health information.

Agenda for Protecting Health Information

9:00 AM to 9:30 AM – Introductions

9:30 AM to 10:00 AM – Icebreaker

10:00 AM to 10:30 AM – Session Overview and Rules

10:30 AM to 10:45 AM – Break

10:45 AM to 12:00 PM – HIPAA and Other Regulatory Guidelines

12:00 to 1:00 PM – Lunch

1:00 PM to 2:00 PM – EHRs and HIT

2:00 PM to 2:15 PM – Break

2:30 to 4:00 PM – Groupwork

4:00 PM to 4:30 PM – Wrap-Up

There are a few things to note in the above agenda. First, it is important that individuals know who is present with them during the session. Introductions serve this purpose. Icebreakers are great ways to set a collaborative tone and are highly encouraged. We will discuss icebreakers shortly.

Two other points about the example agenda; use of group-work and the amount and timing of breaks. Groupwork is critical if you have a skill that needs to be reinforced. Imagine if you were presenting a topic that involved several different departments in the organization. If you had a representative from each department come together and form a group, imagine how much more effective it would be than simply breaking into random groups.

Most people attend groups with who they are familiar. This would hold true in the training session as well.

The last topic is that of breaks.

Most adults have an attention span of about 45 minutes. Our first break was 90 minutes which is about double our attention span. However, the introductions and the icebreaker are normally non-stress-inducing events, and our attention span is not stretched due to the amount of change present in the session. The course overview is what we worry about and it is only 30 minutes in length. Well within our attention span.

If you look at the EHR and HIT section, it is one hour in length. We are pushing the 45-minute mark but because we are skilled presenters, we will be okay. The next section, that of group-work is over the 45-minute mark but it is interactive work that keeps changing.

Breaks then, need to be based on the amount of change being introduced and related to the material presented. If it is dull, monotone material, we do not want to go longer than 45 minutes. If we introduce a lot of material but do so in a moveable fashion, we can push the time to break to a maximum of 90 minutes.

The final point to make about breaks is to effectively read your audience. When you make an agenda, there is nothing that states that you must hold to it 100%. In other words, if you have a topic and the audience is fading, take a quick 10-minute stretch and shorten lunch or end 10 minutes later. You do not want to change the main topics of the presentation or sacrifice content to enable more breaks but if all else fails, err on the side of too many breaks rather than not enough.

Let’s discuss the role and relevance of icebreakers. If you want to set a relaxed tone, it is highly recommended to include an icebreaker. A quick search on the internet will find thousands of icebreaker ideas. If used, the icebreaker should be relevant. Recommended icebreakers for training sessions are the NASA Exercise: Survival on the Moon, Lost at Sea, the T-Puzzle , or trivia. You can ask random trivia questions or construct trivia questions based on your organization. Careful though with this one – you don’t want to embarrass your colleagues ?

Survival on the Moon and Lost at Sea are great group-based icebreakers. The T-Puzzle and trivia are best suited for individuals. If you are using group work, as shown in our sample agenda, it would be a good idea to use a group-based icebreaker.

Turning back to our sample agenda, you can see where there is time for session overview as well as rules. When you are conducting a training session, it is best to provide an overview of what the day will look like. What are they expected to learn and how will they apply it in their positions. This covers the WIFM and drives home the reason as to why they need to be attentive during the session.

The rules are your rules. You may establish that interaction is 100% encouraged however you might make a ground rule that they need to raise their hand. This helps eliminate distractions and keep the session on track. Another rule might be related to phone calls. You might work in an industry that makes it impossible to ask participants to turn their cell phones completely off. However, you may ask them to put their phones on silence and ask them to answer the phone quietly and then leave the area.

Tip: ask participants to email and/or message their direct reports and colleagues to tell them that they are beginning a training session and that their response time might be delayed.

Be sure that your phone is on silent as well! Nothing worse than making a rule related to phones and you being the one that breaks it! ?

Earlier, when we were discussing breaks, we mentioned the need to constantly monitor the audience. This is important, not just from a break perspective, but from an understanding perspective. You may have inadvertently assumed that the attendees had more experience with the material, or you may have assigned pre-work. As you are presenting information, you cannot assume that they have completed the assigned pre-work. It is not a personal affront to you, rather it is knowing that they did not see the immediate relevance or the WIFM for them. It is a good idea to periodically stop and ask the audience understanding related questions.

Our next topic in the training session is the use of handouts. Handouts can either make or break the best-prepped training session. Once you pass out a handout, you have a 50% chance of losing your audience forever. Handouts must follow these guidelines:

1. Not be overcrowded with information. Too much information and you have lost your audience as they will read the material on the sheet in front of them and not pay attention to you.
2. Not be too simplistic. While handouts are great tools, creating too simple of a handout insults the collective intelligence of your group. If you have a mandatory meeting and distribute an overly simplistic handout, you have now lost the respect of your audience. Respect = engagement. Lack of respect = disaster.
3. Be interactive. The best handouts lack key pieces of information that they will glean by paying attention.
4. Be discussed before distribution. To avoid losing your audience, be sure to express to the audience the purpose of the handouts. What key points will they cover, etc.
5. Summarized upon receipt. A brief overview of the entire handout is encouraged once they have been distributed. This satisfies the WIFM question related to the work you have just placed in front of them. Because that’s what an interactive handout is – it’s work because it requires completion.
6. Serve a purpose. Do not create a handout if you don’t need one.

Related to handouts is the use of PowerPoint as a training tool. PowerPoint can be extremely effective to communicate your message, or like handouts, it can spell disaster. Misusing PowerPoint is so common that there is a coined phrase “Death by PowerPoint.”

Tips to use PowerPoint effectively.

• Remember that not every presentation needs a PowerPoint. While PowerPoint is a great addition, not every point needs a visual explanation.
• Adhere to the rule of one: do not lose your audience in information overload.
  • One idea per slide
  • One claim per slide
  • One chart or graph
• Simplify the number of words on a PowerPoint.
• Do not read from the slides.
• Maintain consistent font and colors throughout.
• Do not overuse special effects such as animation or sounds.
• Only use relevant images of good quality – make sure the focus stays sharp if you use a projector.
• Use a title for every slide.
• Avoid carrying over a topic or idea to additional slides.
• Use logical transitions between slides.
• Use appropriate references and citations for your work.
• Run through your presentation at least twice before showing it to an audience – this will help with timing and delivery.
• As mentioned before, have a plan b if the technology fails.
• Do not speak to your slides.
• Do not apologize for anything in your slide. If the content is unclear or questionable, do not use it.
• Download the presentation onto the computer beforehand to avoid loading issues.
• Face the audience when presenting – not the screen.

When the PowerPoint is over, make sure to leave plenty of time for follow up questions. Be sure to leave the presentation powered up so that if there is a question about a particular slide or topic, you can transition back to it easily.

After Presenting

The training session is over. Before your audience disbands, be sure to establish a clearly defined action plan. Too many training session participants leave with good ideas, but those ideas stay in the drawer and are never referred to again. Someone has requested that you present the information. It may be human resources, management, stakeholders, or an owner, but someone more than likely has asked you to present the information. Work with this person or department to have follow up tasks readily available.

Some training sessions are followed up with a working website that has suggestions and tips to ensure that the information was effectively received. Some trainers will walk the floor a week after training and do on the spot check-ups that serve the same purpose.

The final thing that should occur after the training session is a survey of participants about the quality of the presentation. Since you are presenting and they are participants, they inherently have a different perspective of the training than you do. Their feedback can be critical in helping you improve your presentation. Be ready to accept criticism. Everyone needs feedback to improve and it always isn’t positive.

Section 3: Collaboration

Our final topic of this module is that of collaboration. What is collaboration? Collaboration is defined as the process of two or more people or organizations working together to complete a task or achieve a goal. Most collaboration requires a form of leadership.

Collaboration is much deeper than teamwork. In a team, the members work individually to produce a result. Think of a football team. Each member of the team has a different position to play to contribute to the outcome. In teamwork, a person can slack, and the other team members will often work harder to make up for that lack of effort. Collaborating requires that everyone works together to ensure success. A slacker will not be tolerated as collaboration is the sum of everyone’s contribution. There is no working harder in collaboration because they are already producing at max level.

Collaboration also requires a leader who understands the strengths and weaknesses of each member and will help maximize results. Where in teamwork, a leader is there to direct and supervise, in collaboration, a leader is there to facilitate and provide resources as needed.

Unfortunately for organizations, most managers are familiar with team and teamwork but not experienced with collaboration. Teams are formed haphazardly and often complete nothing. Researcher A.T. Kearney found that seven in ten work teams fail to produce desired results. Think about that for a minute. Only three teams out of ten are successful. In organizations, especially healthcare organizations, a 30% success rate is not sustainable.

So, how do we ensure that our collaborative team is successful? Here are tips to help ensure success.

Tip 1: Create a compelling cause. When you are passionate about something, you will move mountains to obtain it. Share that passion and ensure that others grasp that cause.

Tip 2: Communicate expectations. Clearly define roles and expected outcomes. This will help avoid duplication of work and avoid individuals stepping on other’s toes.

Tip 3: Establish goals. Make goals known to everyone and have predetermined measure points to determine success or to identify times to adjust strategies.

Tip 4: Encourage innovation. All organizations are moving – none of them are stagnant. Innovation helps keep the organization moving in the right direction. Innovation keeps your organization ahead of the competition.

Tip 5: Leverage team strengths. Nothing is more frustrating than when an organization seeks strengths outside the organization when the skillset is already present. This requires that a leader knows his or her team members and can use those talents to meet goals.

Tip 6: Accept responsibility. It is okay to make mistakes. Teams and leaders will make mistakes. Foster an environment where mistakes are okay and not penalized. Mistakes can be great learning opportunities and can improve collaboration. Unfortunately, many organizations penalize mistakes to the point where they are often covered up or hidden. Such mistakes eventually come out in the long run and prove to be extremely costly. Where the price of a mistake might be small upfront, the continued efforts to cover up mistakes can quickly become insurmountable. We only need to look at Enron for a case study on covering up mistakes.

There are two side-effects of collaboration that can harm the organization. They are conformity and groupthink.

Conformity is a natural occurrence, and it happens to all of us. Sometimes it is so subtle that we do it subconsciously. Most of us want to be liked. We want to be accepted by our peers and colleagues. When we form a group at the collaborative level, we spend a lot of time with one another and will often change our views to fit the collective norm. We may decide to sacrifice a viewpoint of ours if we find that it is incongruent with the group. It is often easier to get along with others than to express a difference of opinion.

However, these differences of opinion are often exactly what is needed when we are faced with a problem. Diversity is the key to a successful workplace and if we all conform to one way of thinking, we lose the ability to see other solutions. We develop tunnel vision, and this tunnel vision can lead to the worst side-effect of all; groupthink.

What is groupthink?

Groupthink is the result when everyone has conformed and there is no challenge to viewpoints or direction. Groupthink can spell disaster for the organization and those involved.

Here are two examples of groupthink.

The first example of groupthink comes from Kodak. For the longest time, the name Kodak was synonymous to film quality. It was so on top of its industry that the term “Kodak moment” was a tagline that embodied the need to capture the moment on film. Like any major company that develops products, Kodak had a large research and development budget.

In 1975, a 24-year-old by the name of Steven Sasson invented digital photography while working at Kodak. He excitedly showed his supervisor who was extremely impressed. His supervisor arranged for Sasson to demonstrate his invention to the board of directors. The board of directors laughed at Sasson and the technology. You must remember that at the time, the quality of digital photography was close to .25 megapixels. In other words, about 1/30^th of the quality of today’s current smartphones. They were grainy and not comparable to the high quality of Kodak’s Kodachrome print film. One person on the board noted the potential and tried to share his concerns with the board. However, due to groupthink, that naysayer was quickly silenced, and digital technology was not embraced.

Kodak, after celebrating more than 100 years of being the industry leader, filed for bankruptcy due to not embracing digital technology.

Our final example of groupthink comes from the NASA Space Shuttle Challenger disaster.

On January 28, 1986, millions of Americans viewed live coverage and watched as the spacecraft broke apart and exploded 73 seconds after takeoff.

Thiokol, the company that manufactured the O-rings used in the fuel system, called NASA the day before and recommended a postponement in launch due to it being colder than normal. In cold situations, the O-ring did not expand properly and were not tested for temperatures colder than 54 degrees Fahrenheit. On launch day, the temperature was an unusually low 18 degrees. Thiokol was panicked and tried incessantly to reach a high enough level at NASA and share the concerns.

NASA had heard the concerns of Thiokol the evening before launch. Later, in an investigative hearing, NASA reported that they did not take Thiokol seriously because the presentation they gave on January 27^th was “amateur” and “not convincing.” Furthermore, NASA decision-makers fell victim to groupthink and the naysayers were quickly silenced. Groupthink cost the lives of seven astronauts and severely damaged NASA’s reputation.

With these two serious examples of groupthink, how do we ensure that we avoid these pitfalls? It is not uncommon for a member of a collaborative team to hold the position of ‘devil’s advocate.’ This role is designated to solely question the intent of major decisions and to ask questions counter to groupthink. Such questions to ask are what alternatives are there? Is there another solution that should be considered? Are we falling victim to conformity?