‘So, then…….’: How my daughter jump-started my journey to ‘active’ listening

Whether it was sharing a school event or something else, there tended to be several “STs” with a blow-by-blow description of events. I kept late hours and like many of you came home exhausted and wanted a short summary of the day from our children. Most times, I tended to interrupt her after a couple of ST’s and interjected with, “So what happened?” She would then either ask me to wait a painful wait before coming to the point, accompanied by an eye roll, or turn her attention to address her mother or brother. Slowly, I did learn to listen.  

We may blame this lack of listening on a scarcity of time, multitasking, etc. I suspect that many of us are in a hurry when we interrupt our patients. In fact, the 1984 Beckman study showed that 70% of patients were interrupted within 20 seconds and that only 2% finished their thought. Many years later, this is still the case. 

Although I still do, I've started to understand that listening is complicated. For example, we may stay quiet, make eye contact and even nod, but we have “tuned out.” This explains why only about half of all listeners remember what they had heard shortly after someone finishes talking. Two months later, only 25% of the average listener will remember the conversation. Hearing (sound entering your ears) is very different than purposeful or “active” listening. 

Experts advise practicing “active listening.” Active listening has three aspects: cognitive, emotional, and behavioral. This means paying attention to the other person and trying to process their words, show interest, manage any emotional reaction and look for non-verbal cues being displayed by the speaker. Later, if you're unsure of the direction of the conversation, ask them to repeat their message or state your understanding of the issue without judgment. 

Being an active listener is more about how we listen. First, become self-aware of your default listening style. Are you a ‘task oriented’ listener? That is someone like me focused on efficiency and getting to the point or reason for the conversation. An “analytic” listener is more attuned to helping the other person with a solution right from the start.  A “relational” listener seeks to build a connection and probably focuses on the emotional aspect of the message. Finally, a “critical” listener is more likely to start in a judging mode. I think these listening styles align with the listener’s Myers-Briggs or Social Styles (SS) behavioral style. As a “Driver” in the SS behavioral grid, I am probably more inclined to be a task-oriented listener. However, just like leadership styles, most of us are versatile and although we have a default style, we switch styles (versatility) depending on the context, our needs and the other person in the conversation. But just like leadership, good listening starts with recognizing one’s own default listening style.  

As a task-oriented listener, I'm always itching to interrupt to get to the point and bring the “task” to a conclusion. This does two things. Not only does this distract the other person from making their point and leave them feeling unheard, but it also keeps me occupied thinking of ways to respond instead of truly listening. The technique of proper eye contact, nodding, etc., is for naught if I am already planning to respond.  

A good exercise recommended is to become a “non-directional” listener at the outset, one who is not going to interrupt and offer a critique or response unless asked. It has been hard for me to pay attention when, after the first minute or two of the conversation, I am bored and see no value to the conversation. Instead, after a question or two, I should amplify and further promote the other person's thoughts and energy as a “trampoline listener.” I have seen a few leaders demonstrate this concept. At the right time, they augment the other person’s thoughts by sharing a brief personal story to support their point. This further clarifies the speaker’s thoughts. 

Listening is an important, often overlooked attribute in a safety-driven healthcare environment. With the constant iPhone or beeper, it is easy to miss what is in front of us, including non-verbal cues.  

I learned an early lesson when I helped save a patient from an unnecessary procedure. As a second-year, every-other-night on-call General Surgery resident on the “Trauma” service at Grady Hospital, we admitted all acute abdominal problems, auto accidents and the knife & gun club members. An obese woman presented at night with a classic clinical picture of acute cholecystitis. I wheeled her to Radiology for a plain X-ray, confident that it would show a gallstone(s). Besides HIDA and daytime ultrasound scans, no other imaging was available at night. Sure enough, there was an oval calcified mass in the right upper quadrant corresponding to a single large gallstone. I waited outside, completing her paper chart while two radiology technologists shifted her back to the stretcher. One of the techs came over and asked if I had examined her back. She then sat the patient up and asked me to feel the patient’s right back. I found a large, partially calcified wart (dystrophic calcification), confirmed by a lateral decubitus film. Tired after over 12 hours on duty, I may not have listened to the technologist.  

Arnaud Chevallier suggests that leaders should embrace the importance of listening and adopt “question storming” where teams meet to brainstorm questions rather than answers to unleash creativity. Furthermore, leaders need to create an organizational culture of listening rather than simply dictating, for several reasons. Listening skills build strong relationships, improve engagement and communication, strengthen the work environment and ultimately improve retention of much-needed talent. Because engagement is vital to an organization's success, leaders know disengaged employees hurt the bottom line through lost productivity and attrition. Listening to the workforce, allowing people to speak up without fear and providing feedback creates a safe environment. A recent survey shows that 86% of employees feel that they are not heard “fairly” and two-thirds feel their opinion has been ignored. In fact, people are 4.6 times more likely to perform better when they feel heard.  

In a LinkedIn survey of 14,000 employees, only 8% of employees considered leaders to have good listening skills. Listening is a trainable skill. Why are most of us so poor at active listening? We know that while we speak at the rate of about 125 words a minute, the human brain, with 13 billion cells, must slow down considerably to adapt to someone speaking at only 125 words per minute. We are either distracted by other issues or think ahead of the speaker with things like where is the other person going, what do they want, how do I respond, observe the facial expression etc. 

Experts have offered a few suggestions to deal with this disparity. Since we cannot memorize numerous facts, it is better to concentrate on the other person's ideas. Second, hear the other person out to the end, even when they look to us for a response. This technique also blunts our emotional reactions to topics we have strong opinions about and forces us to practice self-control. Listening to people to the end also avoids listening errors because the speaker will invariably repeat something to clarify a previous statement.  

The late Larry King, host of CNN, said, “I remind myself every morning: Nothing I say this day will teach me anything. So, if I’m going to learn, I must do it by listening.” Another memorable quote is “I never learned anything while I was talking.”  

Yes, I am now sure to wait until my daughter has exhausted her quota of ST’s.