Administrators: “Stuck in the Middle”

Administrators: ‘Stuck in the Middle’

Techniques to facilitate successful interactions between operators and staff


Administrators and CEOs of long-term care organizations sometimes find themselves in a communication dilemma I call “stuck in the middle.” They are expected to implement the organization’s vision, mission, policies, and procedures, while honoring the staff and ensuring efficient, productive daily operations. In the process, however, the board’s or owner’s vision may conflict with staff’s on-the-unit situation. The managerial challenge that arises is developing a stream of communication between the operating entity and the staff that flows through the administrator and creates success.
But what does “communication”-that oft-used concept-mean? The word comes from the Latin communis, meaning “common.” In an article published in 1993 in the University of Missouri University Extension bulletin entitled “Developing Effective Communications,” author Dick Lee comments, “When we communicate, we are trying to establish ‘commonness’ with someone. That is, we are trying to share information, an idea, or an attitude.” To effectively share our concepts and beliefs in this way, he notes, it is important to balance listening (receiving) and speaking (giving).

Have you felt frustrated during a conversation because it seemed you were not being heard? With that in mind, ask yourself when speaking, Am I listening, too? Do I really know how to listen? The New Lexicon Webster’s Dictionary of the English Language defines “listen” in this way: “to use one’s ears consciously in order to hear, to pay attention to speech, music, etc., to be influenced by.”

Studies indicate that, of the 70 to 80% of our waking hours spent in various forms of communication, 45% is spent listening. About half of what we hear is retained immediately and, after 48 hours, only 25%. Listening for maximum effect requires that you devote full attention to the person with whom you are interacting, and that means more than simply hearing what is being said. We tend to filter conversations because we are so involved with our own inner chatter. Conscious listening, therefore, means setting aside all of our concerns and really hearing what the other person is saying. It is the ability to hear and feel empathetically.

Can conscious listening be learned? Our culture teaches us to move faster and do more. Paying attention to speech requires that we slow down, be aware of our surroundings, and focus on the present. It means letting go of that inner dialogue. The resulting quietness provides the clarity needed to listen and feel when another person is speaking.

The use of relaxation techniques is one way to become quiet and pay attention to speech. A major obstacle to accomplishing this is simply finding the time. But consider this scenario: You discover that a wonderful way to network is to participate in golf tournaments sponsored by healthcare organizations. Unfortunately, you don’t know how to play golf, and you’re too embarrassed to try the game for the first time at a tournament. You make the commitment to learn the game so you can achieve your networking goals. You take lessons. You practice regularly, improving your game enough to feel comfortable playing with your peers. You then take part in healthcare tournaments and successfully network with your peers. Success is achieved because you allotted time to reach a tangible goal.

This same level of commitment is necessary in learning to listen empathetically. Find a spot that feels pleasant and quiet. Have a seat and get comfortable. As you settle in, become aware of the inner chatter that is occurring. Observe your inner dialogue nonjudgmentally; it will subside if you don’t judge or engage it. Now, begin to pay attention to your breathing rate. Slow it down. Breathe more evenly. You begin to relax. Now, without engaging your own chatter, consider what it would be like to participate in a listening experience that excludes your perspective. Imagine how that would feel. Consider what another person thinks and feels as a vital factor in communication. This is the experience of empathetic listening, and the more practice, the better.

Why is this important? Think about it this way: When you decide to buy a house, do you prefer the realtor who tries to sell you the priciest house in her portfolio, or the realtor who takes the time to listen to your needs and tries to find a house that accommodates you? The realtor who truly listened chose to listen consciously, paid attention to your speech, and influenced you through empathetic listening. You eventually move into your idea of a great home, and the realtor earns a commission.

Bringing the example closer to the professional situation, by listening empathetically, one becomes more attuned to the common issues discussed in conversations conducted with both the operator and the staff. Finding those common issues is important. For example, I have an Israeli friend who has lived in the United States for two years. She became involved in e-mail correspondence with individuals living here who had come from many Middle Eastern countries. The potential for political disagreement was immense. Instead of focusing on political differences, though, my friend encouraged the group to find the “commonness” among them. So, they wrote about children’s homework and their expatriate experiences. This approach allowed the group to see their shared values and ideals. When the ideas of one group seem less foreign, the ability to find commonality becomes more possible.

As you listen empathetically and try to find commonalities, try saying to yourself, Let me see if I really understand this person’s thoughts and concerns. Ask questions to define your understanding of what is being said. When people feel that you want to understand them, they trust you more and begin to open up. The more you sense and express their concerns accurately, and the more you build trust, the more likely it is that each side you are communicating with will understand the other’s position and wish to develop collaborative solutions. In fact, each step you take toward conscious listening will broaden your sphere of influence and build trusting, more open communication between the operating entity and the staff.

To illustrate, imagine convening a meeting between the operator and the staff concerning ways to collaborate on improving the institution. You begin by asking the operator to describe, in two or three sentences, some top priorities. He might say, “I’m concerned about being short-staffed. I don’t understand why staff members call off work so much. Can we hire good, reliable people who will stay in these positions?” Ask a staff member to repeat and interpret the operator’s comment to the operator’s satisfaction. Maybe the staffer will begin by saying, “We don’t work hard enough, and you don’t think we’re good at our jobs.” The operator responds, “What I meant was we seem to have a hard time hiring and keeping people in their jobs. I appreciate those of you who’ve stayed with us and have worked so hard.” The staff member says, “We’re frustrated, too, that some staff members often call off work. The core staff works hard, as you said, and we do need to find ways to hire more people with our work ethic. I have an idea or two.” The staffer then describes his ideas, which the operator then paraphrases until the staffer feels they’re comprehended. And the dialogue continues, with the emphasis being on teaching and practicing empathetic listening.

If the two sides are unable or unwilling to meet, you-the administrator-become the conduit, or the mediator. As a mediator, you must be thoughtful and unattached to any particular position, seeking the best solutions for all. Compromise is not the goal-collaboration is. We’re not looking for people to give up on things, but rather to create a consensus.

There may come a time when the parties will agree to disagree. If the group has become accustomed, though, to a collaborative process, unresolved issues might become less important in the overall scheme of things. If people find that they cannot work in the current environment, they will make a change, either philosophically (change their minds) or geographically (leave). The important thing, for the administrator, is to cultivate empathetic listening and a collaborative attitude over time.

Remember, this is a process that will take time to nurture and develop. But your diligence in this will create substantial changes in the way people communicate in your organization. So, be patient; be unwavering in your commitment. You will find the feeling of being “stuck in the middle” becoming a distant memory. NH

Claudia S. Blumenstock, NHA, is executive vice-president of Living Communities, LLC, a senior development company, and a principal at Copernicus, a consulting firm based in Rochester, New York. For further information, phone (585) 624-7650. To comment on this article, please send your e-mail to

Topics: Articles , Facility management , Leadership