ONGOING analysis of case files at MDDUS clearly shows that many incidents, complaints and claims in primary care arise due to failures in communication. Quality of communication can also impact performance, risk, wellbeing, incidence of burnout and staff turnover.
Individuals and teams fall into patterns of communication and behaviours over time (sometimes referred to as personality) and these can affect others in both helpful and unhelpful ways.
Consider the long-serving senior partner whose strength of character (dominant, fearless nature) is seen to have brought the practice success but who is intolerant and intimidating to some staff, perhaps more so under pressure – or the HCSW loved by patients for being warm and chatty but also viewed as too talkative or inefficient by colleagues.
Each strength or positive quality an individual demonstrates may also manifest as a limitation in relation to how it impacts others. Often we don’t realise this – just as our senior partner might be surprised to see the results of a practice safety culture survey and find that colleagues regularly hide mistakes from him, and often feel they cannot approach him for help. Or the patient-focussed HCSW might be devastated to learn she was not selected to lead a patient improvement project on the basis of not having the “results-oriented” attitude required.
A simple language
MDDUS recognises that effective communication is vitally important in mitigating risk. Over the last decade we have been using DISC behavioural analysis with individuals and teams to help improve communication within practices. DISC is a personal assessment tool used across many countries and in many different settings. It provides a common and simple language by which colleagues can better understand themselves and how they interface with, and impact on, each other. This insight can be used to reduce tension and conflict, and improve working relationships.
DISC is an acronym that stands for the four main profiles described in the model: dominance, influence, steadiness and conscientiousness. An individual’s preferred (or default) patterns of communication and behaviour can fall into one or more the profile types or styles – each of which has positives and potential challenges:
- D types tend to be assertive, to the point and focus on the bottom line. They are often described as forceful, direct, risk-takers and strong willed. Possible weakness include tendency to overstep authority, dislike of routine and being argumentative.
- I types tend to be great communicators, friendly and are often described as motivating, optimistic and talkative. Possible weaknesses include inattention to detail and a tendency to go off on a tangent.
- S types are great team players and good listeners. They are often described as steady, patient and loyal. Possible weakness include sensitivity to criticism, stubbornness, and discomfort with change.
- C types enjoy gathering facts and details. They are often described as thorough, precise, sensitive and analytical. Possible weaknesses include too much analysis resulting in paralysis and inability to voice feelings.
D and I types would be more likely to take an active, fast-paced and intense approach to situations (e.g. a conflict and decision or a change project) and may become frustrated by S and C types who are likely to adopt a slower, more cautious approach, which is often misinterpreted as passive, resistant or (frustratingly) unassertive. D and C types are most comfortable with task-focussed activities (end goals and competencies/processes, respectively), and I and S types tend to place a heavier emphasis on people connections and building harmonious relationships.
An individual’s DISC type or style is most likely to sit across more than one dimension and tends to be a blend. In fact, in your home or social life you may exhibit more of the characteristics/preferences of an opposite style, and these patterns can change over time. Your style is also influenced by factors such as life experience, education, maturity and work role. If time is taken to understand your primary style(s) this will allow reflection on how your approach to communication and behaviour can affect and interface with others in the team, or perhaps patients you find tricky.
Exploring the natural tensions across preferences between you and others (such as how you respond to challenges, how you influence others, your preferred pace and how you respond to rules and procedures) can unlock personal change strategies that will increase the effectiveness of communication and dramatically improve team functioning to reduce risk and increase positivity about the practice.
Learning about other people’s DISC styles or preferences can help you understand their priorities so that you are able to adjust your approach (communication and behaviour) for the best outcome. It should allow you to better predict what will “tick their box”, so that you achieve the best response in your interaction.
Another benefit of DISC analysis is that it helps us understand how our communication and behaviours (and ‘default’ approaches to situations) change under pressure. For example, my own DISC styles are predominantly S and I, which manifests in my preferring to lead collaboratively and support team members to develop in their roles. However, under pressure or in more challenging situations, I am prone to adopt the D style, which manifests as more directive and decisive. I am aware that my engagement with the team then changes quite dramatically and could be perceived in a negative way if I don’t pay attention.
The important lesson here is that if you can reflect on changes and spot how these manifest for you in relation to others, you can pause, take a step back and decide on and practise an alternative response. In some situations becoming more direct and decisive can be a strength, but in my case under pressure I lose the value of other perspectives and this can lead to less effective decisions.
Adapting to the environment
DISC analysis also allows us to see how an individual can adapt to the work environment (act up or supress preferred behaviours), which is important when practice rules, roles or biases can inhibit helpful team behaviours, causing disengagement, frustration or anxiety.
Going back to the examples earlier, our senior partner now being aware of the impact of his approach (and equipped with specifics on behaviours and communication that could limit effectiveness in his interactions with others) can decide to exhibit more S style behaviours (patience, providing reassurance about error reporting, setting time aside to listen). This is likely to prompt the team to behave in a more transparent manner when things go wrong – and even ask for help before a problem occurs – as they are likely to feel more secure about how the GP will respond.
Our HCSW now understanding how her approach with patients is being interpreted negatively by others can plan to practise and demonstrate the behaviours that are perceived to be of more value by colleagues in relation to the patient project. This might be a little challenging at first (and out of her comfort zone) but will become less onerous with practise. Actions might include supporting their ideas for the project with accurate information (showing she’s done her homework) and setting out some detailed thoughts on how the project might be conducted.
Trying out new approaches can be uncomfortable but there is strong evidence that personal intentional change planning can be effective. Limitations identified via DISC analysis can lead to the planning and testing of new approaches in which the responses and personal feelings of others can be monitored, allowing for further revision and practice. Seeing positive outcomes almost always reinforces our intent to plan further change.
If you’re interested in learning more about DISC analysis, join one of our open courses or contact our risk team at email@example.com to arrange a team or speciality group, based session. This will include a pre-course DISC analysis and team-specific content to ensure you are equipped to start your transformation!
Liz Price is senior risk adviser at MDDUS