ABOUT THE AUTHOR David Maxfield is coauthor of two New York Times bestsellers, Change Anything and Influencer. READ MORE Dear Crucial Skills, How can I rid myself of watching TV mindlessly for long hours? Couch Potato  Dear Couch Potato, Thanks for asking! This is a problem that sneaks up on people and has real impacts. Adolescents who watch hours of TV also eat more junk food, exercise less, study less, have fewer friends, and are more likely to be involved in drugs and alcohol. Adults who watch lots of TV are more likely to be overweight, depressed, have cardiovascular diseases, and shortened lives. Wow! However, notice that these are correlations. They aren’t saying that watching TV causes all these ills. In fact, the causation may run the other way, at least sometimes. Think of how it might work: I feel ill and a little depressed. I don’t have a close friend to visit, and I don’t feel up to taking a walk. So instead, I watch a few hours of TV. While I’m watching, it’s easy to down a beer or two and a bag of chips. As this becomes a habit, I go out less, gain more weight, spend less time with friends, and feel worse about myself. So, how do I handle my depressed mood? By escaping into more TV. How can you escape this vicious cycle? Personally, I use the principles from Change Anything. Set a Goal. Decide how much TV is the right amount for you. It might be one hour a day or five hours a week. Make sure the goal is reasonable and within your control. Create a Six-Source Plan. When a habit is hard to change, it’s usually because your world is perfectly organized to maintain it. You probably have all Six Sources of Influence pulling against you. I’ll suggest some ways to get all Six Sources pulling for you. Source 1: Personal Motivation. Left in a room by yourself, you probably want to watch TV. How can you change your motives in the moment? I think we often use TV as a solution to boredom, loneliness, burnout, and bad moods. And it may even work, at least in the short run. It pulls us into a compelling story and distracts us from our troubles. But it’s a distraction, not a solution. And it tends to lead us into other bad habits, as well as take time away from more healthy habits. If you are using TV as a solution to a problem, then finding better solutions to these problems might remove an important motive for watching TV. Track your moods. Put a notebook near your TV, and track what you are thinking and feeling when you get the urge to watch TV. Find out whether you are using your TV to manage your moods and which moods they are. Also, note what your moods are at the end of each day. Some researchers have found that viewers are happy while watching but feel lousy at the end of the evening—as if they’ve wasted the evening. At the end of each day, ask yourself, "Do I feel good about how I spent my time today?" Enjoy the well-deserved feeling of success when you stick to your TV plan. Source 2: Personal Ability. New habits require new skills. If you find it’s taking too much willpower to avoid TV, add some skill. Skill up on better ways to enjoy your free time. First, determine when you watch TV: is it early morning, the middle of the day, after dinner, or late at night? Map out these times and begin searching for better activities that could replace TV during those times. Create your own Pleasant Events Schedule. It’s an old tool, but it’s a good one. The Pleasant Events Schedule is a simple list of 320 activities that some or many people enjoy. You can find an updated version that focuses on older adults here. You can use this tool as follows: a. Check out the items on the list b. Select several that you enjoy and that would fit into your free time c. Schedule them into your free time—put them on your calendar as an alternative to TV watching d. If you discover you don’t enjoy them, pick different activities Sources 3&4: Social Motivation and Ability. Do others around you influence you to watch more or less TV? What is your personal mix of accomplices (people who enable or encourage more TV) and friends (people who enable and encourage less TV)? Change the Mix of Accomplices and Friends. Identify your TV buddies—the accomplices who join you in front of the TV—and then ask them to join you in non-TV activities. Or, add a new friend by finding someone who is doing something you’d rather do—exercising, taking a walk, reading aloud, volunteering, etc.—and join them. When you feel as if you need help, help someone. Or at least connect with someone. Spend your TV time with someone you care about, instead of with your TV. Call your mom, visit a friend, talk to your children, or help your children with their homework. Source 5: Structural Motivation. Are there hidden rewards for TV watching? Can you do something to invert the economy? Take away hidden rewards. Don’t allow yourself to eat or drink while you’re watching TV. Don’t have the TV on during meals. For example, do you indulge in junk food when you sit in front of the TV? Don’t reward yourself while watching. Reward incremental progress. Track and reward your progress every week. But don’t use TV watching as the reward! Find a range of little presents you can give yourself. Change them up so they stay fresh and make them contingent on achieving your weekly TV goal. Source 6: Structural Ability. Is your environment making it too easy and convenient to watch TV? Does your living room, kitchen, or bedroom scream, "Turn me on, I’m a television!" Use convenience and comfort. Make it less convenient and less comfortable to watch TV. My wife and I have one TV that’s out all the time and is located on the wall in our kitchen. But we’ve made sure the chairs there aren’t overly comfortable. After about 45 minutes, no one would want to keep watching TV at our house. Actually, we do have a second TV, but we keep it on the top shelf in a closet near the living room. Whenever we want to watch a longer show (we’re Tour de France addicts) we take down this TV and put it on a stand in the living room. But we always put it away again after the show. These little touches of inconvenience and discomfort prevent us from watching too much. The secret sauce that makes Six-Source Plans so effective is that you use all the Sources all at once. Don’t cherry pick one or two of these ideas. Make sure you have a tactic that will work for you in each of the Six Sources of Influence and implement them all at the same time. Of course, I’ve shared only a few of the many possible tactics out there, and some that work for me might not work for you. Be the scientist. Explore what works for you and then let the rest of us know. Everyone, I’d love to hear what’s worked for you. Please share your ideas for turning off the TV. David Related posts: Lose Weight and Defy Your Critics

Read Joseph’s latest columns on Forbes.com for tips and strategies for changing your behavior in 2013. And Now for the Toughest Influence Challenge of All: Changing Myself We have it all backward. We lament how the world is falling apart because other people won’t change. Health care costs soar because other people eat too much and exercise too little. The workplace is too political because others hoard information and resources. Others have dangerous political or religious views. Others are polluting the planet. And worst of all, "others" come to a full stop before entering the new traffic circles in my town. Sheesh! That’s why we all crave the ability to influence others. If only we could get them to change, our lives would be better. But over the past few years, I’ve gained an appreciation for those with the capacity to influence themselves. Unlike most of us, these successful individuals think of themselves as influence projects. They stand above themselves like interested scientists and consider the habits and proclivities of their favorite lab rats—themselves. By doing so, they develop insights, interventions, and strategies to behave differently. Read more Are You Facing Your Own Fiscal Cliff? If So, Odds Are You Got There the Same Way Congress Did. I’ve about had it with TV pundits and persons-on-the-street who decried the self-interested, short-sighted, infantile politics of Congress during the infamous "fiscal cliff" negotiations. It’s not that I’m not worried or irritated at the behavior that keeps bringing us to these predictable precipices. It’s that in pointing our fingers at Congress, we are distracted from looking in the mirror. Read more Related posts: Crucial Applications: REACH 2012 BIG Idea Video—Joseph Grenny Asks Two Important Questions Joseph Grenny Introduces Crucial Conversations Second Edition Joseph Grenny Says You’re On!: Keep Habits by Competing with Friends

ABOUT THE AUTHOR Joseph Grenny is coauthor of four New York Times bestsellers, Change Anything, Crucial Conversations, Crucial Confrontations, and Influencer. READ MORE Dear Crucial Skills, I love my sister dearly, but her behavior can be very negative and manipulative. Whenever she is discouraged, she develops passive aggressive behaviors and withdraws from me while simultaneously blaming me for our momentary dysfunction. Often, her perspective of self-loathing advances to the point of suicidal threats. In these crucial moments, I struggle with what to do. I feel that I enable her because I cling to her in an effort to prevent the threatened outcome. However, I also feel manipulated because she is using me to fill an internal void. I desire to help her, but I feel stuck in our relationship. I’m trying to set boundaries, but her manipulation and threats directly attack the boundaries I’ve set up. Please help. Signed, Uncertain  Dear Uncertain, The biggest obstacle we face in life is making wise decisions in the face of overwhelming emotion. It’s impossible for most of us to imagine how hard it would be to think clearly when a loved one is threatening suicide. I sympathize with your plight. You’ve tried to set clear boundaries, but when holding your boundaries seems like it could result in your sister making such a cataclysmic decision, it’s natural for you to second-guess your decision to hold those boundaries firm. Since your question involves very sensitive mental health questions, I asked Jodi Hildbrandt, a licensed clinical social worker I deeply respect, for advice. Here are some important principles to keep in mind as you hold crucial conversations—both with yourself and with your sister. 1. Get professional advice before proceeding. You need to describe your sister’s specific symptoms and behavioral patterns to a professional to determine whether she is at immediate risk of harming herself or others. If so, your response should not be to cave into her demands, but to get her compulsory help. If, after consultation, you are confident a significant portion of the issue is behavioral and not purely neurological or chemical, the following advice may be helpful. 2. Your sister’s problems are more about bad skills than bad motives. She has developed some maladaptive habits in order to manage her legitimately painful emotions. Withdrawal, self-loathing, threats of suicide, and passive/aggressive behavior are ways of escaping emotions she has no other skills to deal with. The only way those who love her can help is to help her—perhaps for the first time in her life—develop clear, concrete boundaries that keep her from using others as a scapegoat for the emotional pain she is dealing with. Please be clear that these boundaries are not just for her, they are also for you. Sometimes, the best way for her to learn to better care for herself is to experience others who are willing to courageously take care of themselves. Establish and hold boundaries for your own emotional health and to give her the option of improving her own. 3. Your belief that you can control your sister’s behavior is what is keeping you stuck. Your sister’s threats of suicide have persuaded you that your actions will determine her choices. This is not true. What is true is that your sister may use your actions as justification for decisions in her life, but that is her choice, not yours. The instant you choose to believe it is true rather than her choice, you become an enabler. You empower her to manipulate you and reinforce her own belief that others are responsible for her emotions. She is unlikely to become mentally healthy so long as you reinforce this belief. You are not responsible for your sister’s choices. You cannot control what she will do or will not do. Continuing to believe you can does not decrease the chance of her making a terrible decision. If anything, it increases it by distracting her from the work she will need to do to become more healthy. I’m guessing we’re not telling you something new here. I sense from your note that you already understand these ideas. So I hope by stating them here to simply bolster your confidence that this is an appropriate way to view the situation. With that said, here’s how to proceed: 1. Firmly and lovingly request time to talk about your relationship. I say "firmly" because she may want to avoid this kind of honest exchange. If she does, then be firm—create safety for her by clarifying your positive intentions: "I want to talk because I want a healthy, wonderful relationship with you. That is not what I believe we have right now. I am happy to wait until you feel okay having this conversation, but in the meantime, I will need to keep some distance from you to maintain my own health and peace. I hope you understand that." You are not responsible for whether she takes you up on this now or decides to wait a while. Do not water-down or apologize for the request. In fact, this firm and loving request is your opportunity to model for her the way she needs to care for her own emotional well-being. 2. Communicate clear, written boundaries. Carefully consider each behavior your sister enacts that is unacceptable to you. Let her know the boundary you will maintain if it happens again. Explain why you need this boundary—not as a punishment for her, but as a way of caring for your own needs. Help her understand how you feel when she does these things. For example, you might say, "When you said you were planning to kill yourself, I felt hurt, terrified, and angry. I felt resentful that you would put that responsibility on me when it is not mine. If this happens in the future, I will need to distance myself from you. It is not that I don’t care, it is that I will not allow you to manipulate me in that way. Instead, I will notify mental health professionals that you are at risk for harming yourself, and then will not have contact with you until you have gotten help." Helping her understand the natural consequences to you of her actions—if done in love and patience—can help her feel much differently about her choices. In fact, it is the only thing that can motivate her to change. She is likely so caught up in her own emotional world that she has no idea how her actions are affecting you and others. 1. Acknowledge her emotions, but don’t own them. While discussing these boundaries, be careful to listen to and validate any emotions your sister shares. Just don’t accept responsibility for them. For example, if she says, "You call yourself a sister and you will cut me off when I need you the most!" you could respond, "To you, my decision to not stay close when you threaten suicide seems hurtful and disloyal. Is that right?" Simply affirm that you understand the feelings she’s having and what she believes is causing them. Don’t argue with her logic or tell her she’s wrong. Just ensure she feels heard. 2. Focus and surrender. The hardest and most important thing to do is to be willing to accept whatever will happen in the future without feeling responsible for it. Do this by focusing on what you really want. You don’t just want a sister who is alive. You want a sister who is happy and healthy. You can’t get there from here. You will have to take uncomfortable steps into new habits and responses to do the only thing you can do to increase her odds of getting there. From there, you must surrender the illusion that there is more you can do. You cannot guarantee she will not take her own life any more than you can guarantee that she will become mentally healthy. All you can do is maintain the unhealthy status quo by continuing to do what you’ve been doing. It’s clear you love your sister. My hope and prayer is that some of these ideas will give you greater skill and resolve to do so in an even better way. With love, Joseph Related posts: Confronting Illegal Behavior Confronting a Coworker’s Temper Tantrums Changing Racist Behavior

ABOUT THE AUTHOR Al Switzler is coauthor of four New York Times bestsellers, Change Anything, Crucial Conversations, Crucial Confrontations, and Influencer. READ MORE   Dear Crucial Skills, My sibling and his family are heading for a serious debt problem and possibly bankruptcy. They are trying to cut expenses here and there but still can’t make ends meet. At the end of the day, their monthly expenses add up to more than they make. It seems the only way to avoid bankruptcy would be to make big, hard decisions or to borrow money. In the past, they’ve asked us for financial help. Sometimes we’ve been able to help and sometimes we haven’t. We have a sense that they’re about to approach us again. We aren’t sure whether we want or will be able to help them financially, but we love them and feel deep sorrow for their situation. On the other hand, we work hard to live within our means and struggle with the thought that we shouldn’t have to help others who don’t live within theirs. We’d like to help them change their lives for the better instead of just bailing them out. How can I help my sibling develop good financial habits and avoid bankruptcy? Sincerely,Cost-Conscious Sibling  Dear Cost-Conscious, At the core, your question centers on helping, and defining what help means can be problematic. Often, what one person sees as helpful is different from what another person sees as helpful. So in the spirit of trying to help, I’ll first offer ideas that frame the challenge, and then detail specific topics that need to be considered. Define what is and is not helpful. In Change Anything, we make a distinction between a friend and an accomplice. A friend is someone who helps you and an accomplice is someone who helps you get in trouble. It is often difficult to tell the difference. When you gave or lent money to your brother, you no doubt intended to be a friend, and perhaps you were. But as your brother’s pattern of behavior becomes apparent, perhaps giving or lending him money, or bailing him out becomes the act of an accomplice. Maybe you are acting as an accomplice by shielding him from the natural consequences of his choices. Maybe, by trying to help him, you are denying him lessons he needs to learn. So it seems you need to initiate a conversation with him about what you think is helpful and what is not helpful. I would suggest initiating the conversation prior to the time he comes to ask you for help. The key to having this conversation is to hold it at a time when he will feel safe. Don’t hold it in the presence of other listeners, or when either of you is stressed or tired. Begin by saying what you are trying to do (provide as much help as you can) and what you are not trying to do (tell him how to run his life.) You are bringing up this topic because it is difficult and ignoring it won’t help the situation go away. By initiating the conversation about your intentions and limitations, you are stepping forward to help in a productive way. Diagnose a motivation vs. an ability problem. It’s easy to conclude that if others just wanted to control their urges and their spending, they could show a little deferred gratification and all would be well. However, for many people, the problem is not want to, the problem is can do—more people have a skill-power problem than a will-power problem. And when we try to motivate the unable, we create more frustration than progress. So hold a conversation to diagnose whether or not your brother is unmotivated or unable. If he is truly unable and doesn’t understand what it takes to make and save money or live within a budget, then you can move the conversation to helping him learn new skills that will ensure his long-term success. Engage in a dialogue about the skills he needs to develop and what he needs to actually do to enable his path out of debt. Introduce your brother to a more robust theory of change. For example, teach him the distinction between friends and accomplices. People who need to change are more likely to succeed if they distance themselves from accomplices, turn accomplices into friends, or just add a couple of friends. Help your brother identify those people who are leading him down the path of financial security or financial failure. When you get to the more technical aspects of financial literacy, consider several options. First, ask your brother if it would be helpful to list the people, places, and things that are helping and those that are hindering his ability to manage his finances. Often, just by articulating this list, steps forward become clear. During this process, you can also ask if it would be all right if you shared some of the tactics that have helped you and barriers that have been stumbling blocks for you. Second, you might ask if your brother will consider exploring some other expert resources. There are experienced financial consultants who will help people learn what they need to do to get out of debt—how to budget, live within a budget, increase savings, and so on. In Change Anything, we share what we’ve learned about personal change and we also have a chapter devoted specifically to getting out of debt titled, "Financial Fitness: How to Get out of Debt." We encourage people to identify the crucial moments where they are tempted to spend too much, and we encourage them to find their unique vital behaviors. Here are four common vital behaviors to financial fidelity we found in our research: Track everything. The financially fit record every bit of money they spend so they can improve at planning and budgeting. Know before you go. The financially fit make plans and lists about what they will buy before they go shopping and they stick to that list. Save before you spend. The financially fit automatically apply 10 percent or more of their paychecks to their bills in order to accelerate debt repayment. Hold a weekly wealth review. Once a week, at the same time, the financially fit review their budget, discuss deviations, and make improvement plans for the next week. And to adopt these vital behaviors, the financially fit get the six sources of influence working in their favor. So in summary, reach out to help, dialogue about skill-power, and find some resources that will teach your brother new skills. Doing these things will do more to help your brother than handing him a check could ever accomplish. I hope that helps,Al Related posts: Change Anything: Changing Spending Habits Crucial Applications: Tax Refund Tips to Jump-start Financial Savings Habits Overcoming Career-Limiting Habits

The UnAccountables are gangs of renegades hiding in nearly every organization across the corporate frontier. Perhaps you’ve come head-to-head with the UnAble, the UnMotivated, the UnDiagnosed—or even all three—a time or two. When you found yourself in a showdown with one of these outlaws, did you know how to hold them accountable? Watch our new video featuring these bandits and learn more about our new Crucial Accountability Companion Course at www.vitalsmarts.com/unaccountables. Related posts: Special Announcement: Introducing the NEW Crucial Conversations! Accountability or Forgiveness? Seeking Accountability

According to our recent poll, 43 percent of employees experienced a déjà vu performance review in 2012—negative performance feedback that surfaces year after year. Nearly two out of three employees say they’ve received negative feedback, and yet only one out of three has ever made a dramatic change based on this feedback. The research shows the typical performance review cycle includes managers giving employees the same negative feedback year after year with little effect on performance. One reason performance reviews are largely ineffective is employees lack the ability to put their performance feedback into action. In fact, 87 percent of respondents say they left their review without a plan for how to better meet their managers’ expectations. Here are seven tips for how employees can make the most of their performance reviews this year: 1. Ask for detailed feedback. Specific, behavioral feedback of both your accomplishments and challenges allows you to know the exact behaviors to replicate and change. After receiving detailed feedback, let your manager know you’re eager to learn and improve. 2. Visit your default future. Motivate yourself to change by visiting your "default future"—the career you’ll be stuck with if you fail to improve performance and are repeatedly passed up for promotion. 3. Invest in professional development. New habits always require new skills. Actively develop the skills you need to be viewed as a top performer through training, workshops, or books—but make sure this is only one part of a bigger change strategy. 4. Find a mentor. Changing habits requires help. Find a trusted mentor to encourage your progression and help you navigate the career development opportunities that exist within the organization. 5. Put skin in the game. Tie your performance to your compensation such as making your year-end bonus dependent on your ability to hit your improvement goals. Or set aside a portion of each paycheck. If you hit your goals, reward yourself at the end of the year. If you fall short, make out a check to a political party you oppose. 6. Control your workspace. Make your new habits easier by enlisting the power of your surroundings. If you’d benefit from close association with another team, ask to move offices. When possible, turn off electronic interruptions that keep you from being as productive as you need to be to move ahead. 7. Let your manager see your advances. Eagerly continue on the path to high performance. Nothing heals the wounds of disappointment like surprising and delighting your manager in the future. Register today to join New York Times bestselling author David Maxfield for a 40-minute webinar where he’ll share important insights from our recent research study, as well as applicable tips for making sure you don’t get caught in a negative review cycle. Related posts: Crucial Applications: How to Overcome a Career-Limiting Habit Crucial Applications: Office Haunting—How to Have Scary Conversations at Work Crucial Applications: Tax Refund Tips to Jump-start Financial Savings Habits

ABOUT THE AUTHOR Joseph Grenny is coauthor of four New York Times bestsellers, Change Anything, Crucial Conversations, Crucial Confrontations, and Influencer. READ MORE Dear Crucial Skills, Since our organization runs 24/7, it’s sometimes difficult to communicate face-to-face with all employees. Our managers often use e-mail to communicate important messages, including giving performance feedback. Would you share your thoughts on what is and is not appropriate to communicate by e-mail? Signed,Performance e-view  Dear Performance e-view, When my son, Hyrum, was three years old, he began to sense at times that he didn’t have my full attention. This was the early days of e-services and I was beginning to get emotionally wired into e-mails and other web services. He would toddle into my office and begin chattering about something important on his mind. I would respond minimally. And at some point, he would climb onto my lap, obstructing my view of the computer screen, place both hands on either side of my face, turn my head so my eyes locked onto his, and say something wonderful like, "Dad, do you know what Muffy did today?" In taking control of my head, he was doing more than just trying to focus my attention. He was satisfying his. Our brains dedicate a disproportionate amount of our cognitive resources to observing faces. We become fluent in reading body language long before we master verbal language. Infants can distinguish a human face from inanimate objects or even animal faces. Why the fixation on faces? Because they are the primary tool we use for discerning the intentions of those around us. Our primal programming urges us to assess any being that enters our visual neighborhood. There’s enormous survival value in being perpetually aware of whether those around us intend us harm and whether they’re capable of carrying it out. And nature has endowed us with great facility in making these judgments by reading nuances of the human face. Therein lies the principle for determining when a crucial conversation can be held virtually and asynchronously. The fundamental question is, "Can I do this well without seeing his or her face?" I have a few—not many, but a few—relationships where I can text almost anything and get away with it. Yes, even something a bit terse like, "Your last report was light on facts." And the only reason I can get away with it is because, in these rare instances, if their face puckers up in some unpleasant way, they’ll tell me. They know me well enough that they can imagine the face I had on when I wrote it (curious, but not angry), and if they doubt the mental picture they have of me, they’ll ask. But these are rare relationships. They’re rare because we tend to trust visual data more than verbal. If someone says, "No, I’m not angry at you," but their lip is twitching while they say it, we trust the lip not the words. This becomes problematic in virtual conversations because the massive mental resources that would ordinarily be occupied with scanning your face have nothing to scan, so they imagine it. They might read the words, "Your last report was light on facts" while seeing your face filled with disdain and your lip curled into a snarl. And they’ll trust their imagined picture of your face to give them a proper sense of the threat level you’re communicating. I watched this happen once with a very seasoned executive. She sent a letter to an important stakeholder that her boss, the CEO, later saw and judged to be inappropriate. He called her from overseas while on travel. His first words when she picked up the line were, "I read your letter. I’m disappointed." It wasn’t just the sentence that threw her into a panic. It was the face she conjured in her mind. Her audio and imagined visual experience of that brief exchange led her to flee the company just a few months later. So, here’s my advice: 1. If you need to see the face, don’t write the e-mail. You should always match the bandwidth of your connection with the riskiness of the conversation. If you need lots of visual data in order to ensure your message is being received as intended, wait until you have a high bandwidth connection (e.g., face to face or Facetime to Facetime). 2. If you have to write the e-mail, write it twice. Sometimes, you don’t have the option of delaying the feedback or getting in the same room with the other person (or some equivalent visual connection). In these cases, write the message first to get your content across. Then read it slowly, imagining the other person’s face. Empathize. Try to put yourself in the other person’s swivel chair and imagine how they might feel at each point in your message. Then re-write it with safety in mind. Don’t compromise the content by sugarcoating it or watering it down. Rather, notice those places they may misunderstand your intentions or your respect and clarify what you do and don’t intend for them to hear from you (or see on your face). In less formal relationships, I’ll sometimes describe the facial expression I’m wearing as I write something just to make that clearer! Imagine me looking grateful as you read this last sentence: Thank you for asking this important question! Warmly,Joseph Related posts: Addressing Mediocre Performance Responding to Confidential Feedback Out-of-Sync Performance Reviews

Bad behavior runs rampant in the workplace. The healthcare industry is no exception. The American Medical Association’s Council on Ethical and Judicial Affairs defines disruptive behavior as behavior that "tends to cause distress among other staff and affect overall morale within the work environment, undermining productivity and possibly leading to high staff turnover or even resulting in ineffective or substandard care." Research among healthcare providers found widespread incidence of disruptive behaviors such as verbal abuse, sexual harassment, racial slurs, physical threats, and profanity. Specifically: 91 percent of perioperative nurses reported at least one incident of verbal abuse in the previous year 67 percent of staff nurses reported between one and five disruptive incidents in the previous month One of the most common manifestations of bad behavior occurs between nurses and physicians in the form of power struggles and clashes over roles and personality. One study found that 95.7 percent of physician executives reported knowledge of disruptive physician behavior within their organization. Not only is verbal abuse pervasive, it is also destructive. Research shows disruptive behavior leads to communication breakdowns that affect outcomes like patient safety and employee morale. Specifically, a study of twenty-six medical residents found that failures of communication between physicians and nurses were associated with 91 percent of the medical errors. Verbal abuse also leads to medication errors which harm 1.5 million patients each year. A study by the Institute for Safe Medication Practices found that 93 percent of nurses and pharmacists experience condescending language and impatience from bully physicians when they ask clarifying questions about medical orders, and 87 percent encountered physicians who outright refused to answer their questions. As a result, 75 percent of nurses and pharmacists admitted to having a peer interpret a medication order rather than calling an intimidating physician. Rebecca Saxton, PhD, RN, CNOR, and associate professor at the Research College of Nursing in Kansas City, Missouri, set out to uncover ways to reverse this divisive trend of abusive physician behavior and communication breakdowns. She collaborated with VitalSmarts to create an educational intervention tailored to the nursing experience that included the two-day Crucial Conversations Training course. The Solution: Read our case study to learn how Rebecca used Crucial Conversations Training to improve perioperative nurses’ confidence and ability to address disruptive physician behavior. Related posts: Case Study: Influencer Training Helps Tennessee Health System Achieve 100% EHR Adoption Crucial Applications: Office Haunting—How to Have Scary Conversations at Work Does the path to action still include telling a story?

ABOUT THE AUTHOR Al Switzler is coauthor of four New York Times bestsellers, Change Anything, Crucial Conversations, Crucial Confrontations, and Influencer. READ MORE   Dear Crucial Skills, I have received feedback that my people skills are weak and that I am too direct, and I have been working to improve my performance in this area. I thought I had closed the performance gap, but based on feedback I’ve received, I think the behavior may still be present. Do you have any suggestions on how I might improve my people skills? Too Direct  Dear Too Direct, Given the distance, anonymity, and lack of details of your circumstance, it would be easy to share a few old adages as advice. However, I’d like to be as specific as I can so let me give it a whirl. I’d like to share a few questions you could ask yourself and suggest a few tactics that will hopefully help you and our other readers. First Question: What is the source of the feedback? Often, the feedback we receive comes from a manager. That feedback naturally becomes important, but sometimes you need to clarify that feedback by seeking additional sources. What does a mentor think about the feedback? What does a coworker think about the feedback? What do your direct reports think about the feedback? You are not trying to negate the feedback; you are trying to clarify it, and other perspectives can help. For example, you might have a conversation that goes like this. "Could we talk about a confidential topic? I’ve received feedback that I need to improve my people skills and that I’m too direct." (Notice I didn’t use weak; I think that word is too value loaded.) "I’m wondering what specific behaviors you’ve seen and what advice you would give me." Again, the purpose is to get clarity, not to get evidence to refute your boss. Second Question: Is the feedback specific? In your particular case, I think the feedback is too vague. "People skills are weak and too direct" are both bundles of behaviors or conclusions. Neither will help you improve your behavior and thus your results and relationships. Clearly, the tactics in the first question are related to this issue of clarity. In this second question, the responsibility rests entirely with you to ask enough questions to make sure you know specifically what the feedback means at the behavioral level. What are you actually saying or doing that reflects poorly on your people skills. What behaviors are at the root cause of your manager’s concern? When you receive the feedback, be sure to ask questions for clarity. If you don’t immediately ask questions and need time to reflect on your behavior first, be sure to take the time you need and then return to your manager and uncover specifics behind his or her concerns. Here are a few clarifying questions you might ask: Could you tell me what you mean by "my people skills are weak?" Could you share a specific example of something I did or didn’t do that has caused you to think this about me? Do you have any suggestions for handling similar situations in the future? Similarly, you could ask questions about what was meant by being "too direct." To dive deeper here, ask for specific times when you are too direct. Does your directness show up as anger or sarcasm? When you give feedback, do you roll your eyes? Do you come in with a monologue and seldom ask questions to get another’s perspective? Do you focus on the task at the expense of the relationship? Some managers clearly value accuracy more than harmony—they value getting it right more than they value getting along. The best managers demonstrate that they value both. Do you play "gotcha" but never give praise or encouragement? Are you all business and no play? Do you only "lose it" when there is a deadline or a missed budget, or do you hold everyone accountable for every little thing? I won’t go on and on about the variations of being "too direct," but hopefully you can see what I mean by getting clarity at the behavioral level. At the end of this conversation, you should be more aware of what behaviors you need to change, and you can then make a specific behavioral plan to improve your people skills. Third Question: What can I do to improve? If you have clarity about the issue and that clarity has been enhanced by talking to others, you should be able to make a plan. I turn here to Change Anything: The New Science of Personal Success for a couple of key tactics. Begin by asking yourself, "What results do I want?" You might want your boss to give you a 4 or 5 on a performance appraisal instead of a 2 or 3. Or you might simply want him or her to state that you have improved in your next one-on-one meeting. Do you know your crucial moments? In what circumstances and with whom do you become too direct? When are you tempted to become angry and use sarcasm and not ask questions or listen? When you can pinpoint your moments of weakness, you will be more prepared to behave differently if and when these crucial moments arise. What are the vital behaviors you’ll use in these crucial moments? For example, you might identify these vital behaviors: When I see a performance issue, I will remain calm and ask myself, "Why would a reasonable, rational, decent person do that?" I will begin all conversations with an observation and question, not an emotion and conclusion. If I lose my temper or become sarcastic, I’ll call time out and sincerely apologize. There could be many different crucial moments and vital behaviors, but you need to select yours. And you’ll need to marshal enough sources of influence to help yourself stick to your behaviors. Do you vividly understand what will happen if you don’t improve and what the benefits will be if you do? Do you have the skills to enact your behaviors? Do you have the support of friends? Do you have cues to remind you about what you have committed to do? If you get enough sources of influence to encourage and enable you, you can make improvement almost inevitable. You will have created your own plan which will lead to your success. I wish you well,Al Related posts: When It’s Time to Let People Go Holding People Accountable What Happened: Time to Let People Go

ABOUT THE AUTHOR Andrew Maxfield is director of the Influencer Institute. What does poverty have in common with obesity? Both are conditions—states of being—that result from repeated behaviors over time—patterns of doing. If you’ve read Change Anything, you know that we claim both of these conditions can be dramatically and fundamentally altered by changing the habits that produce them. And habits hinge on pivot points called vital behaviors. Influencer Institute, a charitable private operating foundation funded in part by VitalSmarts, has applied a behavior-change approach to helping people escape the clutches of dire poverty in Oaxaca, Mexico through a partnership with an organization called Cause for Hope. Let me relate a few lessons we’ve learned that can perhaps help you in your own personal change efforts as well as in your training and coaching. First, insist on vital behaviors. There are many important and interesting behaviors, but few vital ones. You’ll know a vital behavior when you see it because other behaviors and results naturally follow if you get the vital behavior right. In the case of our experiments in Mexico, participants who lifted themselves out of dire poverty over the course of several months did just a few key things: They made and kept weekly commitments related to growing a small business. They kept daily financial records of income and expenses. They saved an increasing amount of money each week, even if in very small increments. Take Connie, for example. Now a proud owner of a children’s clothing store, she describes how her monthly income grew from less than $200 to over $400 (and still growing) and how she now has accumulated $800 in savings. Further, her husband’s earnings have improved substantially due to her influence. Her children will have opportunities that she never could have provided without focusing on her vital behaviors. Second, find or create a team. You might think that getting yourself out of poverty is your battle alone, that it’s a math problem involving your income and your expenses, period. And in a sense, that’s true—at the end of the day, you must be the one to enact the behaviors that change your condition. However, engaging the help and encouragement of supportive team members is a powerful component in an influence strategy to change your behavior. This has been the case in our work in Mexico, too. Each participant belongs to a "peer-mentoring group," which provides the vehicle for ongoing peer-accountability, motivation, and learning. At weekly group meetings, participants engage in a ritual of making and keeping a commitment relative to growing his or her small business and reporting on the prior week’s commitment. Group members hold each other accountable for making steady progress and also participate in joint problem-solving sessions. These participants are progressing together in ways they couldn’t (and didn’t) alone. Finally, consider a condition in your own life that you’d like to change. It might not be dire poverty, but there is at least one thing that you can learn from this experiment: results ensue when you pursue the vital behaviors. Related posts: Influencer Institute: Introducing the Influencer Institute—And a Call to Action! How can I help participants who are creating their own change plan in Influencer Training create an actual results statement? Vital Behaviors for Entrepreneurs