Giving and receiving Information is probably the  primary skill required of leaders.   There is no other leadership or management skill that can compensate for poor communication skills.  There are four aspects to communication:  Receiving it, processing it, retrieving it, and giving it.

When receiving information, it is important to pay attention to both verbal and nonverbal cues.   It is thought that 80% of our communication is nonverbal.  People can say whatever you want (or they think you want) to hear, but a lot of times, their nonverbals give away their true feelings.   Similarly, people giving information may assume that the person receiving the information already knows certain things, or defines things in the same manner.  Think about the difference between what a “clean room” means to you versus your 8 year old child.  Consider how differently two people may define “being prepared ahead of time,” getting work done in a “timely fashion,” or “being on time.”  If you are not careful, facts will be forgotten or distorted. This is because both the individual sending and the person receiving the information may unintentionally obscure the message.

There are several ways you can insure that the information you receive will be accurate:

· Take notes. Always write down key information received including what it to be done, how often, by whom and any deadlines.· Repeat back what you think you heard the person say.   Say something like “Okay, just to make sure I got everything, you need me to….”

· Ask questions and clarify vague terms with examples or deadlines.  For example, my former boss used to say “I need this ASAP.”  To me that meant before the close of business, and I should clear everything off of my calendar to get “this” done.  After a couple of years, I learned that it really meant within a week or so.  When he would tell me he needed something ASAP, I would say something like “I have a couple of other things pending, will it be okay if you have it by next Monday.”  Most of the time he said yes, and I was a lot less stressed.

While you may think you understand what you think you heard, you may in fact have gotten it totally wrong. Clarify and verify! To encourage good communication, you need to encourage others to speak freely.

· Show interest by leaning forward, paying attention, nodding in agreement, taking notes, putting your phone on vibrate and so forth.

· Listen to new ideas with interest.   If you are a visual learner (you need to read it or see it) or a reflective learner (you need to get the information and ponder for a bit) then make sure your staff knows that.  Few things are more frustrating for staff than to tell you an idea they are really excited about and feel like they are getting brushed off.   Again, dates are important.  Tell the person “Sam, that sounds like a really amazing idea.  Can you please write it up for me and I’ll take a look at it and get back to you on Wednesday?”  That will be received much better than “Sounds like a good idea.  I’ll think about it”

Information you receive needs to be “stored” so you can retrieve it later.  At the most basic level, we need to retrieve information from our memory.

Creating good memory pathways:

· Hear it (listening and talking), see it (take notes, follow powerpoints) , apply it (ask yourself, how can I use this information? Make up scenarios).  Most people are a blend of different learning styles.  The more different ways you receive the information, and the more senses are involved, the stronger the memory can be.

· Make it matter.  There is a very strong emotional component to memory.  We remember those things we care about and discard those that just take up space.  I am one of the least sentimental people in the world.  About the only holidays or anniversaries I remember are Christmas, Easter and Thanksgiving.  I envy some of my fellow managers who can remember everyone’s birthdays and anniversaries.  Hallmark holidays matter to them.    I have really tried to make myself care, but I don’t, and I forget.  Another example is your address.  When you are living there, it matters and you remember it.  When you move, eventually you forget.  The take home message is that if you want to remember something, make it meaningful to you.

There are many other different ways to store and retrieve information such as computers, date books, PDAs and cell phones.   The medium is not as important as what your write and how you store the information. You can employ a variety of methods to help you remember details, including note-taking, repeating back, memorization, and mnemonic devices.   I have my life diligently set out in my iphone calendar so it alerts me to every meeting and every task.  That may be too rigid for some, but it fits with my temperament.

When giving information, use as many senses as possible (seeing, hearing, touching or manipulating). In addition,

· Speak clearly.

· Use language that everyone understands.  No jargon.

· Vary your tone, volume and pace.

· Provide an overview at the beginning, then move from the general to the specific.  For example: (General) “Today we are going to learn how to bake a cake. Follow along at your station and refer to your cookbook if you get behind”   (Specific) “Open your cookbook to page 485.  Step 1: Preheat the oven to 365 degrees.  Step 2…”

· Use visuals— charts, handouts, diagrams and encourage note taking

· Look at the listener to identify signs of confusion, boredom or frustration.

Encourage two-way flow—ask questions to help them mentally manipulate the information and have them ask questions of you.   Use feedback and reflective listening to keep your verbal and non-verbal communication in sync. Take notes of the main questions and comments and review your notes soon afterwards so you can modify or append the message as necessary.   I often review my notes and send out a meeting summary to everyone who was there.

If you practice all of these basic communication skills, you will often find that your subordinates very much want to do what you ask, but in the past you have been unclear.  When I was in college I had a professor who taught my statistics class using the book that he wrote.  Things that were trivial and basic to him were things we still did not know.  He would fail to teach the basics then get irritable that we were all failing the class (The high score on one test was a 67%).  Chances are, you have “written the book” on how you want your department to be run.  Make sure your subordinates have all of the basic information before just assuming they are being disobedient.  This will greatly lessen everyone’s stress.

Example is not the main thing in influencing others, it is the only thing.  ~ Albert Schweitzer

The very essence of leadership is that you have to have a vision.  ~ Theodore Hesburgh

Leaders must be close enough to relate to others, but far enough ahead to motivate them.  ~ John Maxwell

People ask the difference between a leader and a boss. . . The leader works in the open, and the boss in covert. The leader leads, and the boss drives.  ~ Theodore Roosevelt

The manager asks how and when; the leader asks what and why. ~ Warren Bennis

Leadership should be born out of the understanding of the needs of those who would be affected by it.  ~ Marian Anderson

Leadership: The art of getting someone else to do something you want done because he wants to do it.~ Dwight D. Eisenhower

Preparing for CARF or JCAHO means embracing the basic principles of what they stad for not only in your manuals, but also in the way you treat your consumers, employees and external stakeholders.  The following are the “big three” for CARF which guide the rest of the standards.

All people have the right to be treated with dignity and respect

Before you can assess the environment to see if it treats people with dignity and respect, you need to define who and what you are talking about.  What people?  Consumers?  Referral Sources?  Staff Members? Community Members?  CARF would probably say that you need to be concerned about all of these.  Then you need to look at each of those groups and identify what constitutes dignity and respect for each of them. 

First, Identify who your “people” are.  What age, race, ethnicity, socioeconomic status, educational level, disability, or different abilities, etc.  Make a list of these groups.   Then define what constitutes dignity and respect (or lack there of) for them.  For example, in some cultures, direct eye contact is considered disrespectful,  while in others it is a sign of respect.   One strategy for this is to ensure that your agency has effective training on multicultural verbal and nonverbal communication and cultural norms for the populations you serve.  Another example of a dignity issue  would be working with consumers who cannot read well to identify what could be done to help them complete the intake forms and feel less self-conscious and agitated.  One strategy might be having the forms available (in both regular font and large print and in the languages of the persons served) on the website and at your office so they could fill them out at home.   Yet another example is when someone who is hearing impaired prefers to communicate through sign language rather than wear a hearing aid.  So, make sure interpreters are available.    Finally, at one clinic I consulted with, the people in wheel chairs had to use the entrance in the  back of the building, because that was the only ramp.  Consumers reported feeling like second-class citizens not being able (allowed) to use the front door.  Of course, once management realized this issue, they built a ramp (It was a larger clinic, so that was not an excessive financial burden). These are just a few examples.   Now that you have figured out what you are trying to assess, you can conduct a survey and ask your “people”  what you currently do that makes them feel respected and treated with dignity, and what areas need improvement.  It is vital to do this with at least the consumers and staff.  From there your executive management committee can prioritize improvements.

All people should have access to needed services that achieve optimal outcomes

Again, before you can even start to assess the environment, you need to define what optimal outcomes are in order to identify the needed services.  For example, a clubhouse program for persons who are severely mentally ill will not define their optimal outcomes the same way as an outpatient program for adults with depression.  Yes, you want both groups of consumers to achieve their highest quality of life in the least restrictive environment, but what that looks like will vary greatly.  This is where patient placement criteria and wrap around services become so important.   Providing the best care in a residential setting for 60 days is great, but really loses a lot if the person is simply discharged to a once-per-week group with no place to live and no easing back into the stresses of day-to-day life.    Think about the last time you started a new job.  You had intensive orientation, but (hopefully) you were then provided a mentor for the next few weeks to help you learn the ropes.  If not, you probably made a lot more mistakes.  When we are talking about people’s recovery and quality of life, many times they cannot afford to make mistakes. 

Again, identify each group of  people.  (Do not forget the staff)  What services or tools does each group need access to in order to achieve optimal outcomes?  What are optimal outcomes for each group?  With staff it is easy.  You will be looking at their billable hours, consumer satisfaction, improvement and retention rates.  You will also examine the average duration of employment with your agency.   Staff often cite that they need things like improved communication; additional training; and more interdepartmental cooperation.  With consumers, you will need to identify what the benchmarks are for each group (i.e.  independent living, employment, staying clean, successful program completion, staying out of the hospital or jail etc.)  Often times these benchmarks will already be being tracked by your agency for funding purposes.  Consumers often cite needing things such as access to more services including case management; employment opportunities; affordable housing and transportation.

All people should be empowered to exercise informed choice

This is the third principle, however, it is probably the one most agencies focus on the most.  Informed choice means telling the consumer about the array of options, why you are making the recommendations that you are making and allowing them to choose from the available programs.    This information must be presented in a way that is understandable to the consumer.   We use the American Society of Addictions Medicine (ASAM-PPC).  I go through the ASAM criteria and we talk about each component so the consumer understands the rationale behind my recommendations.  It is important that, when possible,  consumers feel that they made the ultimate decision for the type of treatment they would receive.  In the end, they need to sign a document which verifies that each program option was explained to them, the clinician’s recommendations were explained to them and the potential risks and benefits were explained to them. 

Finally, it is important to use rapid cycle change processes when trying to implement changes.  Make small changes and try it on a small scale, such as in one clinic or department, re-assess in two weeks to a month to see the change (for better or worse).  Evaluate the outcomes and decide to either expand the initiative; modify and re-test or scrap it and start over.   By starting small and reassessing quickly, you save valuable time and money.