When someone on your team isn't pulling their weight, it's not only demoralising for the rest of the team, but detrimental to the person in question. If performance management isn’t put into practice, workplaces can become toxic, which can hamper performance and lower job satisfaction.

High-functioning teams enable everyone to speak up, challenge each-other, and share their mistakes and learning. And it all starts with giving feedback.

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Hands up who's scared of performance management.

Or even just telling a colleague that their work's not up to scratch.

These two birds carry a lot of weight.

If you work in medicine and none of us wants to invite conflict into the workplace.

What happens if you give someone negative feedback that's triggering for them?

Or what if a partner isn't putting their weight?

Or you don't feel like you can offer any criticism?

This week, I'm speaking with Dr.

Clare Sieber, a GP who now specializes in mediation and performance management.

We covered ways that we can see personalized negative feedback, as well as what teams can do to build more psychological safety.

Just as a quick note.

At the end of the episode, we had a little bit of trouble with Claire's broadband.

So the last few minutes were a bit choppy.

We've cleaned it up as best we could, but this is a great conversation for anyone who needs to deliver feedback or wants to consider the effects.

It might have.

If you're in a high stress, high stakes, still blank medicine, and you're feeling stressed or overwhelmed, burning out or getting out are not your only options.

I'm Dr.

Rachel Morris, and welcome to You Are Not a Frog.

Hello, I'm Dr.

Clare Sieber.

I'm a GP based in West Sussex, a mediator of GP disputes and co CEO of the Well Led Provider.

Wonderful to have you on the podcast.

Clare.

Thank you so much for being here.

Um, I'd just like to start off with asking like you're a GP.

How on earth did you get into mediation and performance management and doing all this stuff?

'Cause they definitely didn't teach that at GP School.

No, they did not, did they?

And that's the, the standard question I always get asked.

So I really should have a kind of robot answer now, but I, I don't, um, I suppose I got into to where I am now just through chance and seizing opportunities, having a few mental breakdowns on the way following what I like doing and just sort of seeing where I end up.

So God knows where I'd be in five years from now, but I don't really mind that.

But the story for me was that, uh, I'd always been interested in medical politics and you're thinking, okay, well what does that, how does that relate to performance management?

So I ended up quite.

Early on in my GP career working for local medical committees, which as you know, are the, the bodies that represent GPs and support them with myriad issues that they have.

Um, and I quite enjoyed the legal and regulatory side of it.

Pretty boring stuff for those people, but I, I kind of enjoyed that.

Um, so I went off and did a law degree while I was working for an LMC and while I was being a GP I was also getting divorced at the time.

So I, um, needed something to, I guess take my mind off that.

And instead of doing Couch to 5K or something more sensible, I chose to do a law degree.

And after doing that and carrying on working for local medical committees, I've discovered that I really enjoyed supporting GPs who were having issues with their colleagues, either personality clashes or issues with people's performance.

Uh, they were needing help to, uh, get that person either to pull their socks up a little bit or to get that person out of the organization.

It's quite difficult for GPs that are partners to do that because partners aren't employees and they can't be performance managed in the same way.

And sometimes there are no rules governing, uh, the exit of a partner at all.

You're kind of stuck with them for life once they're in.

So that's how I got into that.

Um, through my mediation work, I met my colleague called Oscar Matthew, who's also a mediator, and he and I then, uh, formed and launched the Well Led Provider about a year ago, which helps practices and PCNs with their team leadership and individual professional development, and also helps practices demonstrate that they are well led for the C QC as well.

Wow.

I, I love that.

I, I had stuff going on in my life, so instead of five couch to 5K, I just did a law degree.

Like, like that's really simple and straightforward to do.

It's just a, a typical GP though, it's like, right, I just need to do something massively, massively stressful and, and difficult to take my mind off this other really difficult situation.

But Clare, it, it's wonderful to have you on the podcast because, you know, in, in all our work, we obviously go around doing lots of courses around resilience, productivity, uh, time management, leadership.

And the refrain we get time and time again is, well, it would be fine, but we've got this one colleague who's either really difficult, who's really obstructive, who not putting their weight or their behavior is causing massive problems for other, for other people in the team, and it's really, really difficult.

To do anything about.

Or I talk to people who are new to partnership and they're like, well, it's great, but we've got this practice manager who just is not performing or the senior partner is, is not performing.

And my first question is, well, are they on performance management?

And, oh, all, no.

Well, we haven't done that, or we didn't want to do that.

And it, it was far too difficult and we really, really frightened of.

A, we really, really find performance management, the sort of official channels of it.

But B, there seems to me to be a lot of stuff that you can do before you even get to performance management that we don't even think about.

And then a lot of the problems that we have is, well, it's a colleague, I'm not their line manager, that I can't performance management manage them.

No one else is doing it.

The behavior is causing problems, and I have no idea why is it that we find this stuff just so, so difficult and we're so scared of it?

Well, because it, I, I guess it's conflict.

And we all, as humans are a little bit on the conflict averse side of the spectrum.

It's uncomfortable, it makes us feel physically and emotionally.

Not very good at all when we are having to do something like that.

So we naturally would, uh, try and avoid it.

That's our, that's in our, kind of our genes, our makeup is an innate thing.

We try and avoid things that make us uncomfortable, bring up all of those fight and flight emotions.

It goes right back to when we were first created.

So there is that thing about conflict and being, being worried about conflict.

For me, a massive barrier to, you know, even just giving someone difficult feedback is that we, we talk about trying to depersonalize things and talk about the issue rather than the person and stuff.

But actually when it comes to performance management, it really is personal.

It is about actually the way that you're behaving is not working and, and sometimes it is about you don't have the skills.

It's not good enough.

You know, it, it, it cannot get more personal, actually.

I, I guess the thing, no matter how much we want to depersonalize it, it's still a criticism of them pretty much as, as well, it feels like a criticism of them as a person.

There is a way of kind of reframing it though to make it less personal, even though I appreciate it is about them.

I dunno if you've heard of something called the SBI framework, situation, behavior, impact.

So you can, if you need to give somebody some feedback which isn't great because they haven't been performing great, you, you do the s bit.

First you describe the situation, you give the context.

So you say something like, you know, yesterday it was really busy at work, wasn't it?

And, and then you describe their behavior.

Then you say something like, we couldn't, we couldn't get through to you.

And when we finally did get you, you said you were too busy to help.

And then you, you're that that bit there of describing the behavior, it's not really something that they can argue with.

You are not saying what their intentions were because you don't know.

You're just saying what they did.

And then you move on to the impact and you say how it affected you.

Again, something that the other person can't argue about.

It isn't sort of personal.

It to them.

So you would say, well, that, that made me even more stressed and it made me feel like maybe you didn't care about my wellbeing.

That's easy, isn't it?

If you can pinpoint some preci precise behavior that is causing a problem, but if they're overall.

What that output is just isn't up to scratch or isn't just very good and you can't really pinpoint the behavior, it then becomes really, really difficult, doesn't it?

It does.

And I guess then you would like to think and hope that you had a good bedrock from which you can then have this difficult conversation on that you had a deal, there was a job description, there was a clear, this is your role, this is what you're gonna do these, these are your responsibilities, this is the accountability lines, and a deal is a deal.

So if a person isn't fulfilling their side of the deal, then you must address it.

And so you would, you would look and say, look, this is what we agreed you were going to be doing.

Here's the data that shows.

It hasn't been done or it hasn't been done well enough.

Let's look at that.

What were the reasons why that didn't happen?

Is it that you, as the leader, have made a mistake, had given somebody too much work to do?

Is it that you as a leader or maybe your predecessors before you came along, put this person in a role that wasn't suited to them, which ultimately our fault as leaders, not theirs?

Or is it a commitment problem?

They're not, they're not motivated.

They're not lazy.

And if it is one of those final two, then you've got to be brave and you've got to do the right thing and move that person on or move them to a different role because ultimately if you don't, that kind of workplace is so toxic.

To have somebody who isn't performing and is drawing the same salary and getting all the same benefits as everyone else who's really pulling their weight, there can't be anything more demoralizing than that.

So you mustn't be scared of doing that because it's actually for the good of the team to do that brave thing.

Yeah, I, I think you've got, you've got to the nub of it and the nub of, you know, actually why this is important.

In first place because yeah, it, it's so profoundly demoralizing to have a, a colleague who, who's not pulling their weight or not not doing it.

And it's not like nobody else knows.

Everybody knows everybody.

Everybody can see it.

And, and long term it's not good for that person either because they must, they must feel it as well.

So no matter how much they wanna clinging on that job, um, for whatever reason, actually long term, it must be profoundly demoralizing to, to sort of know that, that you're really not, not doing great and, and people aren't really valuing the work that you do.

But that's me assuming that people genuinely know that.

Do you find that there are occasions where people actually have no idea that they're, they're not performing well or it's not up to scratch and they're in the wrong role?

Or do people generally have a bit of an inkling about it?

Yeah, on on the surface, it can often appear like people.

Don't have an appreciation of that, but once I spend a bit of sort of one-to-one time, like I do in my mediations with that person who's underperforming, there is insight there.

They're not enjoying work.

They're thinking that they want to leave, even if they don't want, you know, express that to the wider team.

They're feeling it too.

It's sort of zapping their confidence as well.

Okay, so it really is the elephant in the room that everybody can see, but nobody, nobody's, nobody's talking about 'cause they're so, so scared of the, the conflict that, that, that comes with it.

So you talked about these, these, you know, the, the pre-performance management that, you know, the mid performance management and then, then whatever comes, comes with it.

What, what would you do?

I mean, you've already mentioned that, that that lovely framework.

What other things can we do like before it gets to that, to that point?

'Cause many of us won't be in a position where we can formally performance manage somebody.

Often we are not their line manager.

They, they work for somebody else or a different team, but they, their work really, uh, interacts and affects us, or they're a, they're a colleague or, um, we just don't have that authority that there's lots of different reasons why we can't officially performance manage someone.

So there's got to be something that we, that we can actually do before it, before it gets there.

And actually, I I, I, I'm thinking that it's better to be able to sort it out unofficially anyway, before you even have to, to get there in, in the first place.

So let's take that in two chunks.

Let's take that from the position of a team leader, and let's take that from the position of a team member, both of whom don't have any, maybe actual line management responsibilities, which you often get the former in, in the GP setting.

So to be a good performance manager if you like, you need to be performance managing frequently, often.

Colleagues who are frequently receiving positive encouragement, where it's merited about what they're doing are far better to improve their performance even further than those people that just receive even well delivered negative feedback.

Those people actually, their performance tends to decline.

So we need to be doing it all the time, giving positive encouragement to team members.

And often when you ask team leaders if they think they're giving enough feedback, they believe they are.

But when you ask team members, generally the rule is that they all feel like they would like a lot more in the way of feedback.

And then if you look at it as a team member, so you're not the boss.

But you know, there's somebody who's struggling, well, if we were in an ideal perfect team, we would be sort of self performance managing.

A well-functioning team will have this sort of high degree of accountability where people are regularly discussing openly each other's performance, not just the performance of the team, but each other's performance and behaviors.

You've got that sort of high, what they call psychological safety where everybody feels able to speak up, challenge each other, share their mistakes and their learning, and the team just grows stronger and stronger and stronger.

I can't think of many teams, if I'm being brutally honest, that I've been in where we've had that degree of psychological safety where we could self performance manage, but that's the kind of ultimate goal.

And on our, um, Well Led Provider platform, when we give practices the opportunity to do diagnostics, we're asking their staff questions like, do you trust your line manager?

Uh, do you feel that performance management is, is done where it's needed to be done?

Do you feel like you receive.

Good constructive feedback?

Do you feel able to talk openly about mistakes that you might make or mistakes that other people might make?

Those kind of questions to really tease out whether you've got the, the level of psychological safety that ideally you're looking for in a team.

That regular constructive feedback.

Oh, it's so difficult to do that regularly.

Or how, how can you set that up as a team to, to, to do that for each other?

Does it have to be done officially, or do you just have to rely on unofficially keeping on doing it?

I think you'd probably have to start doing it officially and then hope that, uh, as people get more psychological, psychologically safe and more empowered and inspired, they then just start doing it themselves anyway, as a matter of course.

But it, you would hope that every team is meeting sort of weekly, fortnightly, at least monthly and reviewing their progress, uh, and looking at what they've done and what they've learned from it, and maybe what they could do better next time you'd hope.

And if they're doing that, then that would be the opportunity to do that, that bit of feedback, the positive

Yeah, it, and it just strikes me in the, in, in practices, you know, we do do significant event analysis and, and, and things like that, don't we?

But it, it's often quite rightly focused on the event and the processes and what could be done differently, rather than the, you what could you, you know, what would improve your performance?

And often there is.

Unsolicited feedback that needs to be given, whereas all the rules of feedback are like don't give someone feedback on stuff they don't want feedback on.

But sometimes when people have a totally blind spot.

It's really, really helpful.

I'm just thinking back to some work I did with the team, um, not, not, not not in healthcare, um, but the, the leader of the team's like, no, we really need to, to get good, to give each other feedback.

So we set up this speed feedback.

It was like speed dating, so everyone had one minute with, or two minutes with people.

We, we set it up so every single member of the team had two minutes with each other, and they said, one thing that you're doing absolutely brilliantly, and one thing that would make your performance better.

So it's like one, you know, one thing that would be even, even better if, so you were able to give the, you know.

So it might be Rachel.

In meetings you, if you just spoke a bit less and were, uh, spoke a bit slower and were a bit clearer, that would actually really boost your performance.

So it was negative feedback to the couches as con construc, well, constructive feedback.

And people, initially they hated the idea of doing this.

But after we did that on the day they rated it, that was the best bit of the entire day and it was the most useful bit of the entire day.

Um, and I'm just thinking, I don't do that with our team now.

And I think that would be really helpful.

Is that the sort of thing you're talking about?

Yes.

Yeah.

It doesn't need to be so formal, but that's excellent.

I wonder if that team have carried on doing that since you spent that day with them.

I hope they have given how, uh, great.

It, it sort of made them feel.

But just like you should be feedbacking about the significant events, you need to be giving feedback about insignificant events as well.

And the more people have positive feedback and encouragement about the things that they are doing really well, the easier it is for that little bit of negative that you described there to, to land and, and feel okay.

Other sort of tips that I might give are to give feedback as soon after an event is possible.

Otherwise it starts to look like you are, something's changed, and then you are, you, you're kind of looking back and then making, picking and choosing things, events that have happened, uh, to suit whatever agenda it is that you might have.

So do it promptly.

Be nice and specific and also give some specific actions or behaviors that that person could do to make it better next time, rather than just say, sorry, Rachel, you, you, you, you speak too much.

I suppose the obvious action on from that would be speak less, but there could be some something specific there to help you.

It could then be like, and I've noticed that you speak too much in this particular situation or that particular situation, yeah, which would then be really helpful, 'cause then I could be alert to that particular situation where I could, I could do less.

So that makes a little sense.

Feedback as soon as often, little and often.

But if you're in a team where the culture isn't to give each other feedback little and often, and negative feedback, how would, how would you actually start doing that?

You could argue that's a, a bit of a dysfunctional team if it's not able to do that.

And if we think back to Patrick Lencioni and his triangle, his pyramid of how you build, build a team, the, the building block, the foundation is trust.

So you've got to go right back to that.

And to go right back to that is a brave thing that you as a leader will have to do and everyone else you then hope would follow.

And to build trust, you've got to be seen to be, uh, I hate to use the word authentic, but authentic, credible, vulnerable, fallible.

So talk about your own mistakes that you've made and what you've learned from them.

Inclusive, consistent in your approach, all those sorts of things.

And then eventually, once the team is feeling better, it'll be then be able to do those more sophisticated things, like openly talk to each other about how they feel about each other.

And that, that building, but for, for those listeners that aren't familiar with Patrick Lencioni and the Five Dysfunctions of a Team.

I learned about it in my, my team coaching, um, course.

And I guess you probably learned about it in your, yeah, leadership and mediation and stuff like that.

It honestly, it's, it's a game changer.

It's called The Five Dysfunctions of a Team.

It's a really short little book you can read.

It's written like a bit like a parable isn't?

It's like a story, but essentially he says that the, there are all these dysfunctions of a team that, that stack up on top of each other.

And the, the main dysfunction of a team is an, an absence of trust in a, in other members of the team.

Now, it's not about, you know, do I trust that Clare will do her job as a GP, you know, will do a good job of patients?

Of course they trust that, but the trust that they're talking about is that vulnerability based trust, which I think is what you were mentioning, wasn't it?

Do I trust that I can give Clare feedback and she's not gonna be really pissed off with me.

Do I trust that I can admit when I've done something wrong and she'll forgive me, or I'll misunderstand her and she'll forgive me?

Do I trust that that relationship is okay, that we can give each other this negative feedback?

'Cause if you can't do that trust, then you just can't conflict.

Most teams, and this is definitely what I've seen in general practice when I've gone under done team coaching.

It'd be interesting to hear your thoughts.

The big problem in teams is, is a lack of conflict.

Not too much conflict, but a lack of conflict.

So nobody will say what they're really thinking and everything gets swept under the carpet and no one is being honest with each other.

And so the resentments just fester away because they don't have that trust in each other.

And for me, when I learn about that, I was like, that is the entire problem.

I dunno what your thoughts are on that.

Indeed.

But it's so difficult to, to fix that you, it sounds easy one thing, trust, but it's not, is it?

And it's not something that as a leader, I don't believe you can fake either, which is maybe why.

There are so many teams out there that are struggling because this isn't something that you can just kind of read in a book and then do, or get a posh facilitation take person in to help you to do as a leader, you've got to do yourself.

If somebody, if the team has made a mistake, do you say, okay, what did you do wrong or what did we do wrong?

If you did that, you need to change the way you are approaching mistakes.

If you say, okay, how could we have prevented this?

That's a bit better.

But really what you want to be saying is the first thing is sort of, right.

What have we or you, what have we learned from this?

It's a completely different mindset, and you, you have to, um, it takes effort to do.

But you've gotta do it from a, a genuine place.

Otherwise it just does not, it doesn't work I suppose.

And then that brings you into the, the leaders in our organizations.

And do they genuinely want to be leading that organization?

And are the values and goals of that organization are aligned with theirs?

Are they really bought into it?

Yeah, the bottom line, this is all about amazing leadership, isn't it?

But bottom line, you, you can't have good psychological safety unless you've got a good culture that says it's okay to make a mistake.

We're still gonna love you and respect you, even if you make that mistake.

And we're also gonna challenge you on, on it, and we care about you as a person.

Therefore, that's why we're giving the feedback, uh, so that you can, you know, get better in in, in what you are doing.

It's just, in my experience, it's so difficult.

'Cause no matter how much we, we think we've got psychological safety, no matter how much we think we've, we are grownups and we don't have an ego.

As soon as we get criticized, as in someone tells us something that wasn't ideal, our egos jump in, our inner chimps come out, we go all defensive.

We go into the corner and boom, you know that, that that psychological safety is gone.

And that's why it's so difficult as a leader, because whether someone feels psychologically safe or not, that's not, you can't control that.

I mean, you can only control what you've done in order to produce that psychological safety.

But people have got stuff going on in the past in their backgrounds, trauma from childhood, all that sort of stuff, which means that they quite, quite often get triggered with any tiny bit of perceived criticism, even if you've done it in all the right ways.

So how'd you get over that?

My only challenge to that would be that if you are doing really well in your team, you might already know some of those things about your colleague.

Because you'll have just, you'll have naturally shared that Will will have come, come up.

You'll have been socializing a lot.

You may have been as a leader, sort of wanted to show your vulnerability and say, talk about the, your experiences in the past and how they've made you who you are today.

That's a really good point.

And that's why I, I'm a really massive fan of doing some sort of team profiling so you can understand each other a bit better as well.

Whatever it is, it might be the four colors, it might be Myers Briggs, I'm a particular fan of the Enneagram at the moment 'cause that shows where your motivation is and, and, and so it's been really helpful members of my team, it's like, well, you know, that wasn't done so well, but I know what your motivation is so I can sort of see why that might have happened.

And it, it is that Right?

And then, then they feel understood and seen and heard and they're like, oh, yeah, yeah, ab ab absolutely.

And, but most of us in, in teams at work, we, we don't really understand what makes the other person tick, do we?

No, we don't.

And maybe that's, you know, if there's one thing that people could take back from this, it will be to have a go at trying to dig into that.

And you, you'll have to start, you have to be the big person yourself and start open the sort of the box by speaking about your own experiences.

Or getting in one of those test things just to, to then frame the conversation and allow people to talk about their experiences.

And you can start a lot, a lot further back as well, and just.

Have a few more informal connections, right?

And I know that in the book, the Five Dysfunctions of a Team, there's a work bit that goes with it and some suggestions about how you can start to build psychological safety and vulnerability based trust.

And one of the exercises is just share something from childhood that really shaped you.

You know, that that changed your perspective.

'Cause then you're starting to get some understanding.

And I remember being in a team once and, um, this, you know, woman, it was, she's a very high powered business woman.

She's like, I grew up on a farm, you know, I have a gaff of milk, but milk the cows every morning.

Everyone's like, we did not know that.

And, and that, that just builds some, like, I understand you're a little bit better now.

And I always think in, in, in teams, particularly in healthcare where people are, are dispersed and seeing patients and hardly ever in the same room at once, we are missing even those informal getting to know you chats around the coffee machine that says, actually I'm having a really hard time with one of my kids at the moment.

They're not in school so it's really stressed me at falls, me at home.

So I might be a little bit more reactive in meeting.

So can you give me a bit of leeway?

Oh, well, once I know that, oh my goodness, we are gonna, we are gonna be treating you very differently now, but that might not have come up if my, if I've just been stuck in my room seeing patients and I'm not going out for a coffee break or a lunch break.

So that's a great thing to do.

A a, like a team speed dating, like you said, The speed dating criticism, speed criticism.

You could do speed.

Uh, tell me how you got here today.

Not, not on the bus, which is I suppose how some people would answer it or, you know, tell me about something important to July four, why do you work here?

And then once you've done a round of that sort of speed dating, you are only probably need 90 seconds to get something meaningful out of everyone.

Then have a go at doing the criticism, uh, speed dating bit.

See how differently it, it lands.

I think people are really grateful for the constructive feedback when they know it's given in a, in a good spirit.

In fact, I read somewhere, now, I could be completely wrong.

I think it was Google or some, some, one of the tech organizations in the past, I dunno if they do it today, but they had a, a mandate that every week you had to go and tell one person, you had to go up to 'em and say, I need to tell you something that's really awkward for me to say, but I think it'd be really useful for me to say this to you and, give them some constructive feedback.

And so they, they all knew that they all had to do it, and it massively put up the, the feedback.

And then that does increase, A, it does help with psychological safety.

Of course, you need to be giving them the, this is what you've done right as well.

But also, I mean, I dunno about you, but.

Lots of people come and tell me about, you know, I enjoyed that talk, or, or, I really love that podcast and stuff, and, and I love, I love hearing that, by the way.

Please keep emailing it and telling me how much you liked the podcast.

Great.

But there are times it's been really helpful is when someone said to me, Rachel, like, should I listen to your podcast the other day?

I did think it, it could have been cut down by 10 minutes.

And that's helpful.

Or I didn't hear, I didn't really get that point about that.

Or you speak a bit fast, you know, at the time I'm like, Hmm, well you don't understand podcasting.

But actually I go away and think about it and I'm like, yeah, they're right.

And that changes things and that genuinely improves stuff.

I, I've rarely really improved what I do through wholly positive feedback.

Have you read the book?

Black Box Thinking?

Oh, Matthew Syed, yeah.

Yeah, and I think it is in that book where the, they talk about James Dyson, the adventure of that very, very famous vacuum cleaner, and how he came across as patented sort of three-dimensional structure by failing multiple times with other different structures.

It was, it wasn't known that that particular structure would be the right one.

He just found it by making mistakes with everything else and sort of tweaking as you go.

The best teams learn from their mistakes and build from them, and have that kind of constructive disagreement going all of the time, and they're the ones that kind of soar.

so really important, and I think most teams just do not make any time for team development like this.

They'll do a bit of training on this or that, but they won't think about how we actually working together.

What we like, how do we understand each other?

How could we improve the psychological safety here?

And un, unfortunately, as you said, that there's no one thing that you can't wave a magic wand and boom, you've got psychological safety.

It is built up over long periods of time of understanding each other, of apologizing to each other.

Actually, I think I've said this on the podcast, but it's been very bizarre in my, in my career.

I don't often have massive arguments with people, but I do remember one day, I think it was on my second house job or something, I was absolutely exhausted.

I, you know, I was the end of my tether and I got into the ward and one of the healthcare assistants was just really rude to my registrar, who I absolutely adored, and I just snapped.

I said, how, how dare you, you know, be so rude.

He's only, he's been up all night, you know, blah.

And I was, I really laid into her.

I, I never normally do that.

And, um, we had a real altercation.

Anyway, left it a day or So, and I went back to the ward.

Next time I saw her, I went up to her.

I said, I am so sorry.

I'm so sorry.

I was at the end of my tether and, you know, and she said, oh, I'm sorry as well, and blah.

And actually, you know what?

Like after that, I, I thought it was gonna be really awkward, but oh my goodness.

Like she was my biggest fan.

And I was like, but I've just been awful to you.

But the relationship was so much better.

And I have, you know, and that's happened to me quite a few times.

You've had this like, big thing, and then you've apologized and you've been humble and you've said, I'm so sorry I wasn't myself and I didn't, you know, mean that.

And then that's built up even more trust bizarrely.

I, I dunno if you've found that at all, but it's, it was very weird.

Definitely it's, it is a bonding experience.

Probably more endorphins than you get from eating a bar of chocolate.

I had a.

similar experience when I was an SHO, um, doing a ward round with a consultant, asked for a gas on somebody, and I didn't appreciate that the gas was a sort of semi-urgent one.

I did it the next morning.

Uh, you know, first thing like you do with people on respiratory wards, and.

When she found out she was, she was crossed, 'cause this person had deteriorated.

And luckily they were okay, but it could have been worse.

And, um, it was very upsetting.

But I, the next day on the ward round with her, I said, I'm really sorry.

I didn't appreciate that, um, you wanted me to do it that urgently.

In future, whenever you talk about gases, I'll make sure I'm really clear about whether it's an immediate one or one that can wait and be routine.

And she said, really, look, it's okay.

I should have been more specific.

Um, and it's hard with all of the juniors coming in and, you know, I get a different junior every week, but I, I will now with you, make sure I'm clear.

And then we kind of had a, we didn't actually hug, but it felt like we had a hug and made up.

And then she was my favorite consultant for the rest of that, that, that, um, time on the respiratory ward.

So yeah, it, it, it does happen.

So funny, but often so fear conflict.

But actually if we navigate it well, it can really help.

Yeah.

You just got to be honest.

Say, you know, look, this is really difficult.

I'm shaking.

I'm a bit sweaty.

You and I have haven't.

We've had some issues and I am, I don't really know how to say this, and this is probably all gonna come out wrong, but I want to try and make it better.

You know, that's not gonna land badly, is it?

And they're not gonna care that you maybe stumbled with your words, maybe picked a slightly bad moment for them.

They're not gonna care about that.

And I guess it's communicating your good intent, it's communicating your, this is my intention in this conversation.

And also communicating that you are respecting them and like them, and you are assuming good intent from them as well.

And then you can pretty much say anything as long as it's not accusing.

I think it's the, it's the accusational.

That, that, that makes people defensive.

You can give feedback and you can like, like you send you back to your S, SBI framework, you're stating what happened.

As long as you're not accusing.

And we did, um, I listened to podcasts about talking about people going over the net, which has been absolute game changer for me.

Um, there's a book, which on my bookshelf just behind me called Connect by, um, David Bradford and, um, is it Carol Rubin?

Anyway.

They were on the Rangan Chatterjee podcast about how to build really authentic relationships.

So they teach a course at Stanford University and they were talking about the fact that in any conversation, there's what I say and do, and there's what you say and do, and we can see that.

So we both know that.

But then there's what I'm thinking and my intention and what the other person's thinking, intention.

And as soon as you think you know what the other person intends or is thinking you are, you are over the net.

So if I came to you and said, Clare, you were really lazy yesterday, well, I don't know if you were lazy or if you just forgot, or if you were really stressed and you just couldn't cope, but saying lazy, that is well over the net or not listening.

I, you might been listening, but you, you know, so as soon as you start, that's when people get defensive.

Exactly.

So if you go back when I was talking about the SBI, I, and that situation that I made up, I said that, that it was busy, that person was difficult to contact, and when we did contact them, they said they were too busy to help.

I didn't, uh, in that bit say you, you were lazy, you were work shy.

You, you were not a team player.

I, I stuck to the facts 'cause it's much, doesn't really invite an argument then.

And then, oh, well I didn't, I wasn't lazy.

It, it forced the other person to just sort of talk about it in a different way rather than go down that rabbit hole.

So we've talked about how to sort of raise stuff or, or, or give the feedback.

This is sort of like the pre-performance management.

What if you do have an individual that, you know, you've tried giving, you know, these sort of informal, constructive feedback.

It's not really been landing, the behavior continues, or they are refusing to acknowledge that their skills really don't fit into that, into that job.

Um, I'm, I'm, I'm very conscious.

I do also want to talk to you about the deal or no deal thing, 'cause I think that's something we, we massively get wrong as well.

What do we then do?

How do you then progress that?

So then you've got to formally performance manage it.

You've got to, there's no other route that you can go down there, except maybe that person resigning, but that doesn't always end so well.

It's not to be seen as the panacea that sometimes people think it is.

You've got to formally do it.

And then I would say that the majority of people listening to this probably don't have the skills to do that.

How many of us doctors know about employment law?

I did a law degree, but the law degree doesn't really touch on employment law.

That's the bit you go to next if you want to then do your sister kind of conversion thing.

So I don't really know that much about employment law.

You need to get someone in who does.

It might be a very good practice manager or manager in your organization, or it might be external people.

And then they will go through that deal or no deal thing.

Here's the deal.

Did you deliver your side of the deal?

No.

Okay.

Why was that?

Okay, so this is what we're gonna do, and it might be moving that person on or moving them out.

And I think this is the problem.

Most of us are absolutely petrified of performance management.

Doing something wrong of ending up in front of a tribunal.

And so are you saying that most of us absolutely shouldn't do it unless we're experts in it, or we should only do it under expert guidance?

Either, but probably the former.

A lot of practices outsource their HR to, to various companies.

And, and everyone I speak to who uses those services speaks so highly of them and that they're really good value for money.

And these people know what they're doing.

Because as you've correctly identified, employment tribunals are incredibly expensive, they're incredibly lengthy, they're incredibly stressful.

Reputationally not a good thing either.

So if you don't know HR law, don't start performance managing somebody formally,

So you would get somebody in to do it or you would do it, but under guidance from that, that, you know, you'd run everything past them, you'd make sure you'd, you, you'd check stuff.

How, how would you suggest doing that?

So that, I think that would probably depend on the person who's going to be doing it, whether they feel confident enough.

Perhaps they feel conflicted and then they definitely shouldn't.

Um, but if that person has any, any doubts about their confidence and ability and being able to handle it and still work in the environment with this person, then I'd say get someone else to do it.

Great.

So you can genuinely get somebody in to be in a meeting with you to do the performance management for you and make sure it's done properly.

Yeah, yeah.

And I can imagine that is money absolutely well spent.

And it's, and it's, and it's good to be, make sure you are, you know, not, not just for you to protect you, but also to protect the other person and make sure, you know, they have the best experience they can of, of that.

Now what happens?

And I think this happens quite a lot, well, I anecdotally I've heard this happen is that as soon as someone knows that they're going to be on the performance management thing, as soon as they get that letter, they go off sick with stress or they then accuse you of bullying.

I've seen this happening so many times in, in practices with poorly performing, it tends to be actually with practice managers, um, poorly performing, um, maybe portfolio doctors.

I, I, I don't know.

It's just I'm hearing about it all the time.

So if you wanted to perform in somebody, manage somebody, and they go off sick, they start talking about bullying or discrimination, stress at work that those are kind of red flag, beep, beep, beep, formal HR required.

I wouldn't go dabbling with that.

I would get help.

So really the, the, the answer here is don't be scared of, of progressing to formal performance management, 'cause you sometimes have to do that, but get, absolutely, get the expert help that you need to do it.

If anything, we're probably sometimes doing it a little bit late later than we should have.

yeah, I was just about to ask you, do we do it too early or too late?

Too late and the, the ship has sailed and you know, it's all got very toxic and very difficult.

It has.

I mean, the classic is somebody's underperforming, so let's do an appraisal.

We haven't done an appraisal on them for 10 years.

You know, you're not, that's not the right one.

You shouldn't be doing the appraisal right at the beginning when you have no, no issues at all about them.

That should just be part of,

And I think the other thing that we, that, that stops us is like, we feel really shamed and feel really bad that actually we haven't really been clear about their job role, this the whole deal or, or no deal thing.

Presumably anytime is better than no time at the beginning, before they even start it's best to have it.

But if you haven't had it and someone's been in a job for like five years, how do you go around creating the deal then?

Because, you know, clarity is, is kindness as, as Brene Brown says, and often just unclear expectations, that's really stressful at work actually, isn't it?

And I know that, uh, health and safety executives say that one of the main causes of stress at work is just not being clear about your job role.

Actually.

What am I expected to do here?

So how would you go around, you know, creating that, that deal, that that job role description?

Yeah, well, that's all us as leaders, if we haven't.

It clearly stated what the deal does is.

And it happens a lot, that people are walking around without job descriptions.

There are people walking around without contracts, nevermind job descriptions.

But there's, that's when you just have to say, look, it's come to my attention that we don't actually have a really clear job description for you.

Um, let's sit down and let's talk it through and mutually co-design something.

See what you get out of it.

It might be that you then have that discussion and realize that this person you've got in that role is wasted almost in that role and they'd be much better suited somewhere else.

Or that this person you might talk to, the bit about their career development, where they want things to go and realize that this is your future practice manager together in that case, and hope that by doing that, you're not going to end up in, in some problem and you will be able to agree what the deal is.

And that those conversations would be really valuable.

'cause you know, if they're, if you are wanting to put something on the job role that they don't wanna do, you can then go, oh no, that's interesting.

I didn't realize you didn't like doing that.

Or that wasn't in your skills.

And can we cover that somewhere else?

Or can you learn it?

Or, or ever.

So I think, I think job description roles are so important.

And even not just the administrative, administrative staff, but you know the amount of doctors and GPs and that.

No, I'm not sure actually am I expected to do this or that?

And I think the problem is we are so used to as doctors doing everything.

I remember as a junior doctor, the entire coronary care nursing team at some point decided all their phlebotomy certificates had run out.

Like literally overnight they'd run out.

And then they called me and said, sorry, we are not allowed to do bloods anymore, so you gotta come do everything.

And it's like, as a junior doctor, you genuinely feel if no one else will do it, you've gotta do it.

'Cause you know you genuinely can.

I think we bring that with us into all our, all our other roles and still think, well, if there's no one else to do it, I need to do it.

But then it's not really clear.

And again, that causes stress.

So, so being really clear about what are our expectations?

I think even, even partners, when they're doing their clinical work.

It's really good to have the, what's the expectation of a clinical session when you do it?

Of, you know, and because I know that portfolio doctors want to feel that you, you know, it, it's equitable when you're doing the clinical sessions, it's equitable what you're doing, and obviously with the partners of running the business.

So that's completely different about what they do in their other sessions, whatever.

But actually, what is it that is expected of a doctor that is on duty today doing this or doing that, and the, the triage calls and blah, blah.

Just think clarity, but how, how do you get, how do you help practices get that clarity for people?

So, first of all, you've got to get 'em to understand that it is, it is worth doing and it's necessary to, to do and to have job descriptions, stand books, job plans, a partnership agreement, cause it just cuts down the amount of stuff that they're, you couldn't kind of argue about or the problem then sits on top of, um, and it pays for itself.

Sadly the work that I do with partnerships was a problem.

The majority of them don't have that sort of basic, the basic deal if you like.

They don't have it written down anywhere and it's not even clear in their heads, the basic dealers.

And they're the ones that end up in more pickles than the ones that have all of that basic.

And is there a difference between like a, I mean, a partnership agreement is pretty formal, isn't, isn't it?

You know, it's the, the, the terms of the partnership.

But it strikes me that when you're working in a team with, with colleagues and you say it might not be a GP partnership, it might be a, a team of consultants where they've got sort of their job plans, but those are very sort of official.

How can you create that, that deal between you about what we are expecting of each other?

That's not too like, you know, 'cause otherwise it's illegally and con contract speak, isn't it?

That's sort of a team co-designing its own round rules really, isn't it?

So that would be a leader saying we could do better or clearer about what, what our expectations are of each other.

We don't often talk about that, so let's all sit down for a couple of hours and see if we can agree on some ground rules about how we behave, how we talk to each other, and how we deliver the clinical work, and then do it in the group.

And that's often where the conflict comes, isn't it?

It's like when one person thinks it's totally fine to be on emails till midnight and that's the way they've chosen to work.

And then other people who can't be or wanna put boundaries round.

And then the, the midnight person who might be completely inefficient during the day is like looking at the other person going, well, you are really not pulling your weight where those people have like got up at six in the morning and you know, worked through.

And there's that misunderstanding about, about what's expected.

That's, yeah.

But you, you'd hope in that conversation you'd be able to tease out the 6:00 AM early risers would be able to, I'm a early riser and the midnight owl will say I'm a midnight owl.

Uh, so, and understands the, these humans that you are working with and how, what us all tick and how we all work, it's go, goes right back to that whole, yeah

. Rachel: to under.

Understanding each other, connecting, getting to know each other.

So important, isn't it?

So, so important

. Clare, we we're nearly at the end of our chat.

Gosh, doesn't time flow when you're having fun.

Are there any other principles that we've not covered that in your work, in all the mediation and the well led provider stuff that you do it, it is just really, really important to bear in mind?

I, I, I would just say it's more of the same, having human connections with your work colleagues.

Socializing, making sure as a leader you are allowing that to happen and enabling that to happen and giving people the time that.

Making sure that everyone's communicating very well out.

The boring stuff, how much coffee you've got left in the jar and how's everyone's weekends been.

And, and the more people are communicating effectively, the ease will be when a problem arises and they have to have a slightly more difficult conversation.

And the earlier they'll be able to raise that because they'll be having these kind of structured time and everyone's together in the room so things won't fester.

So, yeah, I, I would make sure that your team are interacting on a human level with each other as well.

Another case of prevention is much, much better than, than cure, right?

And the, the, the problem is, is we, we all think we don't have time for this.

I don't have time for team development.

I don't have time for these informal interactions.

But the consequences of not having it is, well, the more minor consequences is increased turnover.

People will just leave, they're not happy, et cetera, et cetera.

The huge consequences are complete breakdown in relationships.

You know, your partnership crumbles, you end up with maybe a practice manager who's not putting their weight for years and years, the practice goes down, or other doctors who are just completely toxic and other pe you know, it, it, it's much, much worse if you don't do this yet the amount of people that do not set aside the time to do it.

And, you know, I'm, I've been really challenged by our conversation today as well.

I'm gonna go back to all my team go, right, let's regular appraisals, let's do some speed feedback, let's make sure we all have job descriptions or the deal that we signed up to written down so that you know, we are just gonna prevent this stuff coming up in the

Yeah, and it's patient out as well.

They're affected by this kind of stuff as well.

It goes right back to the patients, and that's something that generally brings, everyone can agree is something that they don't want to see, but it does go all the way down to that.

So it is absolutely worth doing, even though we all have no time to do it.

We've got to find some time and make some time to do it.

Thank you for reminding us that actually it is about, it is about patients.

It's about good outcomes for everybody and being happier at work and, and just, just performing, performing well, but we overlook it so, so often.

So Clare, thank you.

It's been so brilliant to chat with you and I'm sure we're gonna have to get you back, uh, to talk about much more.

I'd love to dig more deeply into the five dysfunctions of a team as well, because I think that's just really, really fascinating stuff, isn't it?

if people wanna find out about you, hear more about what you do, how can they get hold of you?

Yeah, so I, I'm on LinkedIn, Clare Sieber.

Clare without an I, and I'd love to hear from anyone who's, wants to gimme some feedback or, uh, just wants to chat, to chat a situation through all, you know, just peer support like we all should be doing for each other.

That's great.

So we'll, we'll pop details about well LED provider and your mediation business and we'll, we'll put your LinkedIn stuff in the, in the show Notes.

So please do get in contact with Clare.

And, um, if you have feedback about the podcast, please email me.

hello@youarenotafrog .co.uk.

I would just love to hear it.

And it, it's really important.

I'd love to hear the good stuff.

But I would also like to hear your suggestions for improvement or suggestions about what topics you want.

Um, that would be, that would be really wonderful.

So please, please do get in touch, and I would encourage you to read the book, the Five Dysfunctions of the Team.

It's just really, really helpful to me.

And a lot of the work I do is, is based around that.

So Clare, thank you so much for being here.

Thank you, Rachel.

Thanks for listening.

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