Culture Focused Practice

 Hey, hey, hey, Dr. Tara Vossenkemper here, and you're listening to the Culture Focused Practice podcast. Welcome for the first time, or welcome back. I'm happy that you're here. It's good to see you. So we are doing a mini series, a two part episode, one part Culture Lab series, calling it a miniseries. This theme of the series is the clarity gap.

So what you think you're communicating, but totally are not. The focus is that sneaky space in between where you think you're communicating and what your team is actually hearing. And our goal is to talk about where confusion creeps in, how we clean it up, and how to spot whether we are dealing with an actual clarity issue and accountability problem, or both.

Today's episode is the culture lab, so this is us figuring out if this is a clarity problem or an accountability problem or both. Episode one was about not being as clear as you think you are, and episode two is about creating clarity without micromanaging. So if you haven't yet listened, I would say go back and listen to those episodes and sort of prep you for today.

If you'd rather just dive in than just listen and hopefully you get something out of this if you haven't already, subscribe to the podcast. That way you can stay up on any series as they drop or binge listen into any, you know, previous episodes and slash or just stay up on whenever things are coming out.

So let's go, shall we?

The intention of the Culture Lab is to go through real life scenarios. I want to bring you realistic practice scenarios that probably have happened and slash or are likely to happen to at least one of you, if not most of you. And I will say that they are likely to happen to me. Some already have, so.

If we think about a diagnostic lens with regard to this conversation, the core question that we are trying to assess is whether or not in the scenario the issue is a clarity gap and accountability issue, or both, because addressing one of those things is different than addressing the other.

Okay. We have three scenarios we're gonna go over. The first is the flaky clinical lead. The second is the chronic meeting talker. You could also say meeting interrupter, but we'll go with talker. And the third is half assed documentation. All right, so the scenario, the flaky clinical lead, the scenario is my clinical lead keeps telling me she's on it in quotes, but deadlines are still being missed. I don't want to micromanage, but I feel like I'm constantly circling back.

All right, here are the questions here. Here are the things that come to mind with this. First and foremost is this role clearly defined. So ownership over timelines, expectations around communication, expectations around accountability, expectations around when things get off course for the people that the clinical lead is responsible for, what follow through should look like with regard to the people, the clinical lead, um, direct report, so to speak, as well as upward communication, you know, what does follow through look like as it relates to discussing things with leadership or maybe with the director of clinical ops?

That's one thing is, is everything clearly defined? Have you gone through and have you made it very clear what is expected of this role in every aspect?

So when your clinical lead says she's on it. I would just dive into that a little more deeply. What, what does on it mean to this person? How do they understand on it? You know, they're on it and then things keep getting missed.

Another thing is, is everything in writing, this is a ridiculous, it feels so silly to say this out loud, but I mean, it's genuine.

Is everything in writing are the due dates in writing the deliverables, the key objectives of the role. Is everything not only communicated, but also written down so that somebody can go back and reference this thing if they're just sort of floating in that space between two people as they're talking.

That doesn't count to me. If something isn't in writing, I mean, I can speak for myself, it's just out of my head. It's not gonna exist. I need it in writing. I need to be able to go back and reference this thing, especially when it becomes relevant. So if I'm dealing with an issue related to a conversation we just had.

I need to go back to that conversation to remember, okay, here's the details. Here's how I can work through accountability with this, you know, clinical lead or clinical direct report, for example.

If expectations are not documented or reinforced, we've got a clarity issue. So if we're not clear with this person about what's expected around their role in all of it, around ownership around measurables, around the processes and systems. That's a clarity issue. That means that we need to spend more time sharing with them, detailing with them, everything that's expected, as well as getting it in writing.

If everything is in writing, and deadlines continue to be missed. That my friends is an accountability issue. You can have a little bit of both, so what can be really helpful in teasing out if something is a people issue or an accountability issue is when you get clear on clarity.

So when you can close that clarity gap and you still see things like deadlines being missed, now we know for certain this is an accountable accountability issue.

We've exhausted all of our efforts on this end with regard to clarity. Everything is clear, everything is in writing, everything is out there. Boop, the problem keeps happening. That's an accountability issue.

Here are some things though that I want you to be thinking about, and these also relate to solving the clarity gap.

One question you can be asking yourself is, have I made it clear what done looks like? So maybe you're frustrated because this person is constantly circling back and you're constantly telling them details. You're constantly going over things with them. If you're just frustrated and you're, or maybe you're just sort of in, in robot mode, you just keep answering questions without thinking about it.

Consider. You haven't made it clear what done looks like. So just reflect on that. Have I been very clear around what done is and have I communicated that to this person?

Second question, to reflect on something that feels relevant is, have you been vague because you're worried about being too bossy or you're gonna come across as too micromanagey, or you want this person to just take initiative and own it on their own?

Or what role have you played in this with regard to being vague and the you're worried that you're gonna come across in a certain way, whatever that way looks like, it's gonna vary from person to person. So have you been too vague, basically.

A third thing to reflect on if you are running into this issue, especially consistently, but if you're running into this issue, and third thing to reflect on is do you trust this person or are you avoiding having a harder conversation?

So is there something around the relationship with this person that is holding you back from, I mean, engaging in deeper dialogue around something, or do you just not trust them, like there's something about this person that you just don't feel very settled with.

That is worthy of deeper exploration. I don't have an answer for you right now because I'm not exactly sure what the problem is. If it's a you thing, if it's a them thing, if it's a history thing between the two of you, no idea. So we can't go there. However, the question still remains, do you trust this person? Are you avoiding having a conversation with them?

So that's, those are the things I'd want you to reflect on. And again, the breakdown for if you're a clinical team lead keeps telling you she's on it, but she keeps missing deadlines and she, you're like, I don't wanna micromanage, but I feel like they keep circling back,

Clari fy first. Have I been explicit about everything that is expected? And have I written it down and have I communicated it directly? Is everything out there? Like somebody new could come in, look at this, pick it up and run with it. Like, okay, cool, I get it. If so, that's an accountability issue that's a people issue. If not, might just be a clarity issue where you need to get very clear. I hate how much I'm gonna say clarity in this episode, but you know, here we are.

Second scenario. Actually, no, I lied. Next steps. So from that clinical, here's how you might handle it. So not only do you have getting clear about stuff and you know, figuring out if it's clarity or accountability, you have own questions, your own things to reflect on.

Your next steps, of course, would be getting specific, like I already said. Documenting expectations, seems like a big duh, and I'm gonna say it anyway, in writing, not only if it's, if it's a project and the scope and the timeline, et cetera, regular check-ins. If it's an ongoing task, then having a measurable setup related to that task, potentially- something you need to have some expectations documented. And then again, if clarity already exists, then shift it over to accountability.

And so this is where you would need to really layout these are the consequences if this doesn't happen. And then your responsibility at that point is to hold that line. That is accountability, holding somebody's feet to the fire and following through if they don't follow through. Okay?

Our scenario number two is the chronic meeting talker or interrupter. So one of our team members domes every meeting. Others don't speak up, and I'm not sure if it's a personality thing or a systems thing.

So let's break down, shall we? You're gonna see a lot of themes in this. This, you can, you know, sort of take what I'm saying and generalize it across these themes. Just follow along and you'll see what I'm talking about. Have you outlined meeting structure? So this is sort of the breakdown things to help you figure out, okay, what is going on?

Have you outlined meeting structure? Have you ever talked about participation expectations? And have you ever set time boundaries? So those are some things to consider. Additionally, is there a norm for turn taking? So this is where we get into a little bit of the like group dynamic norms. You know, there's always storming, you know, forming, storming, norming, re storming, or renorming, whatever the language is. I forget.

Regardless, is there a norm for turn taking or is it that people are expected to sort of self-regulate and self modulate without guidance? Have you ever been clear about the norms for turn taking, which ties in with that participation expectations? Have you tried redirecting in the meetings themselves and nothing sticks? Have you tried, um, making sort of a global statement about sharing the airwaves? Have you tried inviting others to speak up, lean into that space. If the structure isn't clear about what is expected out of people at meetings or like what a meeting agenda looks like, that's a clarity issue.

If you've never explicitly said, this is what it looks like, this is what I expect, this is what it should be, that's a clarity issue. If, however, the structure is clear and you're seeing the same one or two people, let's say, let's say one person just for simplicity's sake, you're seeing the same one person, you know, uh, continue to dominate, that's an accountability issue.

And maybe it ties in with culture a little bit. I think accountability and culture go hand in hand very frequently, but it's for sure an accountability issue.

So here are the things I would have you reflect on. First and foremost, have I set the tone for inclusive discussion or am I hoping that people just figure it out?

Kind of like, am I like leaning back and hoping that they figure it out? Or am I saying, Hey, I want equal airtime folks, like, let's all chime in. Let's all give each other some space. If you tend to take up a lot of space, maybe hold yourself back. If you tend to take up not very much, maybe push yourself forward. Let's, let's coexist in this space. Let's share the air.

Another thing to reflect on is have you addressed this directly? So by directly, I mean gone to this person and said something directly, you could address it globally. Like I just gave that example for in a meeting where you are saying something broad about what's expected, but you also could go to the person directly and say, Hey, I'm noticing this thing happening. Boom. So don't dance around it. But have you had a direct or frank conversation about this with that person?

Three, and this ties in with culture piece. Is there anything about psychological safety that's at play here? So if you have one person taking up a lot of space and a bunch of other people who are taking up little to no space, maybe there's something with regards to psychological safety.

And so just sort of thinking about, is there something about safety, emotional safety, psychological safety, belongingness? Like is there something happening here with regard to that concept?

The next steps I would recommend that you take, there's a few here. One is set meeting norms and review them as a team. If you've never done this, then this can prove be very helpful and effective. If you have done this, I would encourage you to do it again. So you are making sure that what is expected is explicit, saying that out loud to the people who are also engaged in that process, including having it in writing, of course. So those meeting expectations, those norms should be in writing. They should live somewhere at your practice.

Another thing is to privately name the pattern with the person who's taking up a lot of space. So this might be, I would not do this. I do not think criticism should be done. Like, I don't even think of it as a dressing down, but like a discussion like that should be done one-on-one, it should not be done as a group.

A global statement to the group about sharing airwaves that feels appropriate to me. Having a one-on-one conversation around, Hey, I need you to, I need you to tone it down in meetings. I would never say it like that, but that needs to be done privately. So naming this pattern with the person being honest and straightforward and also kind and empathic.

Maybe asking, I might say like, Hey, I noticed this is happening in meetings. I wanna know where you're coming from, how you're feeling in meetings, what your thought process is, et cetera. I would try to seek to understand first where they're coming from, maybe if they're feeling anxious or they're picking up on some of the culture stuff and they're the joker, you know, they're always making the quips and the one-liners, and it might be coming from a source of anxiety, which kind of points to the meetings being problematic.

And maybe they're not being psychological safety, but if it's something where they're like, yeah, I just thought it was, you know, we all got too engaged. I would have a conversation around, I'd so appreciate your like willingness to go there. What I think is happening instead is that your presence is maybe overshadowing some of the other people's willingness to engage.

And I might say, 'cause I am this person, like I, I tend to take up a lot of space. I have to constantly sort of keep myself in check. I might like, I don't think that's even self-disclosure, I think it's obvious for anybody who knows me, but I might just say like, I relate to this, I relate to this need to like bring myself back down.

And if I didn't, I would say, you know, I can understand the, the desire and the need to share and be open in meetings. And my fear is that it's, it's shutting other people down a little bit. And so it could be, if you relate to the other side where you feel shut down easily, I would just play that angle, so to speak.

So again, privately name the pattern, have a discussion with them. Another thing I would do is, um. I would do this just in the meeting itself. You could do this in advance the meeting where maybe you shoot an email to some of the quiet people and say, Hey, I really would love for you to, um, share some of what's going on for you in the meeting.

Or here's the, an agenda item. Can you maybe lead this discussion or whatever? Inviting them, making sure to invite them to share about something specific. Or just making sure to invite them to share in advance of the meeting even started starting, excuse me.

If you are not comfortable doing that. Another way is, like I said, making a global statement at the beginning about airwaves. Like there's only so much, and we all have different default tendencies. Some people might take up more, some people might tend to take up less, and that the ask sort of the, the push that I want from people is to push yourselves in whatever direction you don't tend to go. So people who tend to take up less, I want them to be out there more versus folks taking a lot of space, bring it in a little bit so you could make it global at the beginning of the meeting, or again, you could invite people in advance, especially the quieter folks to share a little more.

Okay, that is the chronic meeting talker. Our third example slash scenario is the half-ass documentation.

This one is notorious in group practice ownership and group practices. Scenario. I keep finding incomplete or late notes in the system. I've mentioned it multiple times in meetings, and everyone nods like they get it, but it keeps happening.

Okay, so here's the breakdown. Some things to consider. Have you made your expectations around documentation clear? Not only timing, but formatting, compliance, is this in writing? Is this shared with everybody? Do people, have this been changed? And people don't know what, what's expected, you know? So as is everything around documentation crystal clear and has it been effectively communicating, communicated, excuse me.

Another like maybe caveat or added piece is, do team team members know what complete, I say that when quotes actually means, so when you say complete, you might be thinking signed, sealed, delivered. They might be thinking complete is, I got the bulk of it done and I have a draft saved. So being sure to clarify what does complete actually mean?

If expectations are not clear and they're not consistent and they haven't been communicated, that is likely a clarity issue. If they are and then behavior continues, you keep getting half-assed documentation, now we're looking at an accountability issue.

Here's some things that I would say you can and should reflect on. Number one, are you being passive aggressive about in your communication about this? Or are you being direct and saying, Hey, this is the expectation, this is the timeline, this is the formatting, this is what needs to be done.

Instead of, you know, I wish people got their notes done on time. That's not helpful. That's, that's passive aggressive, you know? So being direct in your communication.

I would ask that you reflect on are you treating an issue as global when it's specific? So, for example, if there's just one or two guilty parties out of a 30 person team, I'm not gonna go outta my way to make this big announcement at the group, and maybe we have some things in writing.

A specific issue typically is accountability or culture or people issue. If you're not seeing global patterns, it doesn't tend to be a clarity issue. It tends to be a people issue, but specific, it tends to be more people or accountability related. So if you are treating this as global, when it's actually specific, you are treating it as a clarity issue when it's really an accountability issue.

So that's something to consider and keep in mind. And what's your comfort level? If it is specific? What's your comfort level and holding people accountable? How likely are you or are you not to do that? And what does that mean about the practice that you are indirectly building?

Another thing to reflect on is have I made space for people to admit if they're confused, to admit when they need help? Have I invited confusion? Have I said, Hey, this is how we do notes. What's confusing? Tell me what you're getting stuck on. Tell me what's a struggle to do. Notes. We have spent meetings processing how people do notes. Like literally as a group, we just treat it as sort of a town hall. And the question is how do you get notes done effectively?

How do you get them, get them done in a timely manner? What are your hacks for getting notes done? And that is, it makes it okay for everybody to share some of what they go through and what they do and how it's helpful. And so may might be that others take something away from that. Or it might be that you're realizing everybody's confused and now we know that it's clarity rather than, than accountability.

Another thing to reflect on, is there anything that you're telling yourself about this that is not helpful or true or beneficial or, you know, useful? Are you sort of saying that nobody cares about notes and they don't, nobody cares, they don't care about getting things done on time. They just don't. They don't care about all the work I put in.

So just be mindful of how you're thinking about this. I hate this notion of like, what story are you telling yourself, but kind of like, how are you making meaning out of this? How are you saying, what are you saying about this thing that's happening? Are you attributing it to like character issues, for example, or laziness or some sort of, you know, is it's all the people versus are you assessing it in a systematic way to figure out if it's clarity or accountability? And then from there, are you making the moves that you need to make?

So just be mindful of how you're thinking about it and what you're saying to yourself about it.

Okay. So next steps then about this. So first and foremost, I would re-clarify what done means with regard to documentation. Assuming it's a global issue and, and we need clarity, then I would write down, I would in writing everything that's expected, timing, formatting, compliance, clinical quality, et cetera, all my expectations would go in writing as well as consequences for not adhering to those expectations. So that's one thing.

Second thing, I wanna hear from the team. Then I have all of this in writing, and maybe I've communicated it directly in a meeting I. I wanna hear back from them. Okay. How are you understanding this? How is this different from what you've been doing? How are you understanding this? How will you implement this?

Talk to me. You tell me now how this is living inside of you, how this is landing for you. Last piece here for the next steps, there has to be some sort of follow up. So I said, I think I said about done. What done means for documentation, including what follow up means, if things or what, um, like a disciplinary, the consequences for if something doesn't happen.

There has to be a clear consequence plan. There has to be something in place that if this doesn't happen, this is the outcome, and we have to hold true to that. We have to make sure that they're actually getting the thing done that they say they will get done.

Okay. Here are some final takeaways. Clarity and accountability are just two little peas in a pod. I don't know how many peas typically come in a pod, but there are two, they go side by side. They go hand in hand. You absolutely need both. But do not conflate them. They are not the same thing. They work together very well. Equal parts important. They're two separate entities. Two separate things.

Both can also be happening at the same time. So I did when as we were talking, I think I was mostly teasing out clarity from accountability. But know that sometimes you might need clarity and you might still have an accountability issue.

And what is great is that when you get clarity, the accountability issue, just it's so clear, it's so obvious now that we have an accountability issue instead of a clarity issue. Very important distinction.

A few other things to consider. I think just a couple questions maybe for you to reflect on.

One is what am I assuming people understand that I haven't explicitly said? This might be hard. So a, a interesting way to go about getting at this is asking people about a process or a system or something in place at your practice that you think is very clear. Asking them how they understand it and what they remember you saying about it.

And/ or you could just connect with your leadership team and say, Hey, how am I, in what areas am I weak with regard to assuming people understand something that I haven't explicitly said? Like, tell me where this has happened before. And then you can sort of see it from the life in front of you.

It might not be a, a live version, it might be something that's happened previously, but it could still be helpful to have a real life example.

Another question to reflect on is where am I avoiding accountability? Because I haven't set the stage for clarity. So what's interesting to think about here is that if you are not being clear, you're sort of indirectly able to avoid holding people accountable.

Accountability is hard, y'all. It's hard to hold people accountable. It's uncomfortable. It can be very uncomfortable to do. And so if we can lean into, we don't know what's actually happening and, well, I'm not sure if it's accountability or clarity. Cool. Then be clear, create clarity, close the clarity gap down to basically nothing.

And now you clearly have an answer for if this is an accountability thing. And then if you are avoiding it, that is absolutely something for you to process and reflect on and figure out what is it about this conversation that makes me very uncomfortable, or the outcomes maybe I'm afraid of? What's the, the way that the conversation may, might unfold, that I'm worried about?

What's the relationship with this person that has me concerned? You have to reflect further. That's a you question to answer. What is it about accountability that you're avoiding?

And that's it, folks. That's our day. That is our Culture Lab in a nutshell, some real life scenarios. I hope that they're helpful for you.

My final ask, of course, is that you subscribe to the podcast and join my Culture Focus Practice membership. You get me live twice a month, one q and a, one training. Anything you want, whatever is on the docket, if you add something to it, it'll get done. My thought for this is that it's really beneficial for people who need some support in bringing concepts to life.

There's so much information that's already out there. I think having information is easy. It's everywhere. You can get information anywhere you want to. What is much more difficult is applying that information to your own practice. That's for me, what the membership is about is how do we take something theoretical and make it real?

How do we make it actual? That's what I wanna help you with. That's what that membership is about. So, and of course it's all culture focus, which is a, I hope at this point a big fucking duh. You've been listening at all to this podcast. The culture piece is just of the utmost importance in my world and my mind and my life.

So. I so appreciate you being here with me and, uh, tune in next time. Who knows what'll come up. But whatever the next episode is going to be, it's gonna be awesome. Thank you for making this incredible. I will see you next time. Bye.