What Goes Around Comes Around: Keep practice communication on track with the Awareness Wheel

Shari Tastad RDH BS, Pathways Coaching LLC
Fran Pangakis RDH, Pangakis Consulting 

Congratulations! You have just completed a very productive morning schedule. You’re feeling great! Your career in dentistry is just what you dreamed it would be….Or is it? 

You reluctantly walk into a staff meeting (not your favorite part of owning a practice) and “it” begins. You remind your hygienist to take digital photos on recare patients. In a flash, arms go up, eye contact intensifies, her face turns red and she frantically replies, “I don’t have time.” Communication quickly comes to a standstill and you decide that it just isn’t worth spending more time on this issue. You retreat and decide you will do it on your own (or not at all). This recurring breakdown of communication has confirmed to you that staff meetings ARE a waste of time!

Communication is a tool that we take for granted and something we don’t learn in dental school. It takes practice. And it’s worth the work. The ability to process and facilitate “people information” (information about self, others, and your interactions) will bring you more meaningful experiences, good feelings, and better connections with others than any other skill. To build this skill requires awareness. Keys to clear communication revolve around being able to verbalize what you observe, think, feel, want, and are willing to do.

Good solutions to topical, personal, and relational issues grow out of the rich soil of complete and congruent awareness of self and others. For complete and honest communication, it is important to start with five key pieces of information: what you see, think, feel, want, and are willing to do. All five are distinct yet interact with each other. By using a tool called “The Awareness Wheel,” you can learn to more effectively process important information about yourself and others. 

In the above staff meeting the doctor asked the hygienist to take digital photos (what the doctor wanted) and the hygienist said she had no time (what she was thinking). Many pieces of the communication are missing from this interaction that would have helped each person understand each other at a deeper level and improve communication in the office. The more you know about yourself and others at any moment, the more effective you will communicate in a wide variety of critical situations. As a leader you are the person to make the difference. By learning to bridge impasses, you will initiate change within your dental office.

We use a powerful tool with our clients known as the awareness wheel. By utilizing all spokes of the wheel it allows you to communicate your entire message. It is a fabulous tool to listen through as well.  Imagine having an awareness wheel tattooed on your forehead. All information passes through the wheel as it is received and delivered. All inbound and outbound messages passing through the awareness wheel would minimize misunderstandings and conflict and stronger relationships would be developed.  The spokes of the wheel go as follows:

Observing: What do you observe about your self and the other person. Observations include verbal and non-verbal data taken in through the senses: sight, sound, touch, smell, and taste. Your senses are like a good journalist; they observe, report, and describe, but they do not interpret. There are three major elements in spoken communications, though they have a disproportionate impact on what is received and believed: what is actually said accounts for only a fraction of the message; we put more stock in the way something is said, its vocal and tonal message (remember the admonishment from your mother: it’s not what you say; it’s how you say it); but by far the greatest influence in communication is the visual impact (what is seen). Without ever hearing a word, you make meaning from various kinds of visual data: context, time, space, texture, design, accessories, clothing, and body language, among others.

In our initial scenario of the staff meeting the doctor might have noticed the hygienist’s rate of speech, her intense eyes, her flush skin and the intensity in her voice. The hygienist might have noticed the dentist’s posture, composure, and the tone of his voice.

Look and listen for signs in yourself and the other person.

Tips to consider:

  1. Notice individual patterns. Every body has a body signature!
  2. Let yourself see and hear all the data
  3. Pay attention to conflicting data: saying one thing verbally but body language says something else. Remember: the body speaks its mind!

Thinking: What do you “think” is going on. This “meaning” contributes to your reaction. Your beliefs, interpretations, expectations, ideas, opinions, and theories influence your perception of sensory data. Thoughts are influenced by your past, present, and anticipated experiences. Your beliefs set the parameters for what you think is possible, how you feel, and what you want. Your interpretations represent how you put the world together. And your expectations are how you organize the future.

Perhaps the doctor expected that the hygienist would say “No way!” and therefore made the request in a less than positive way. His beliefs and expectations sabotaged his attempt to communicate. 

Tips to consider:

  1. Treat your beliefs and interpretations as working hypotheses.
  2. Consider the possibilities. Several interpretations may be possible.
  3. Be aware of your beliefs and expectations as you approach a new situation
  4. Prepare to switch. Could you possibly change your belief or change your expectation?
  5. Ask yourself: “How are my thoughts influencing what can happen in this situation? Are they limiting?”

Feeling: What do you feel. Feelings are your spontaneous internal, physical, and emotional responses to the comparison between what you expect and what you experience. Some people consider feelings to be risky, irrational, and dangerous. As a result, they fear their feelings, do not trust them, and/or try to ignore them. But if you study your feelings – feel without acting – you’ll discover that your feelings are actually very predictable and rational. They come from somewhere, and how you act on them can have a positive or negative influence on the outcome of a situation.

Feelings are information. Your feelings – what ever they are – draw from other parts of your awareness. They are information about you at that moment, important in their own right. They do not have to be justified, denied, or avoided. They are part of “what is.”

Several feelings can arise at the same time. At times, they can be a combination of positive and negative feelings. For example, it is possible to feel frustrated, disappointed, and hopeful all at the same time. Feelings can not be controlled by ignoring them, nor can you do away with them by denying them. Sooner or later they will come up to haunt you. Rather than disregard your feelings – negative as well as positive – see them as internal clues to “what’s happening.” They are your barometer; they take readings on your external and internal world. By acknowledging your feelings, you are taking control of your world.

Words used to describe feeling are words such as angry, happy, afraid, bored, excited, disappointed, concerned, and anxious.

Tips to consider:

  1. Attend to your feelings. Ask yourself: “What am I feeling?” Put it in words.
  2. Attune to your body. What do recurring physical sensations tell you?
  3. Learn about your responses. How you respond to others reveals how you are feeling.
  4. Change your activity to change your feelings.

Want: What do you want. Define your real intention. Wants are your desires, hopes, and wishes for you, for others, and for your relationship. As such, they reflect your core values. Wants can be tentative hopes and dreams or deep desires of the heart. They generally imply moving towards or away from something or someone. Wants are motivators. They give you a tentative direction for the future. They may be your mini plans, goals, objectives, or priorities.

Wants are important for two reasons: (1) over the long term, they demonstrate your real (not just stated) values; (2) they propel action. When you connect with what you really want, you focus your energy and release a strong force.

You can have wants for yourself, for others, and for us. One usually has multiple wants. In our example the dentist has several wants: to give the patient the best care (desire for self and others); to increase production (for us); and for his staff to participate at a different level (for self and others).

Tips to consider:

  1. Ask yourself from time to time: “what do I really want?” This will give you increased energy.
  2. Discover the wants of your team/others. This will assist you in motivating them.
  3. Clarify wants (your own and others) to reduce confusion.
  4. Check for hidden wants when you’re feeling desperate. Are they keeping you stuck?
  5. Use awareness of your intentions to help you send clearer messages, using an appropriate style of communication.

Action: What you do. How do you proceed to ensure that the request is followed through or behavior enhanced or changed. As you act, consider what you have done in the past, what you are doing now, and what you are willing to do going forward.

Actions are behaviors, activities, actions plans, solutions, promises, achievements, and accomplishments.

Tips to consider:

  1. Be honest in talking about what you have done in the past and what you are willing to do differently.
  2. Be realistic.

To successfully use the Awareness Wheel in your practice, get your whole team involved and learn these new communication skills together. In practicing these skills, they will be available to you when you most need them. The following example and blank Awareness Wheel will help you get your practice communication on track.

Start by examining each of the five zones over five weekly staff meetings. Distribute copies of the Awareness Wheel and ask each staff member to fill in each zone as you work through them.

Week One, start with the observing zone and practice reporting just what you see and hear. Pretend you are a video camera and reporting only the details as you see them. Using a typical office event as an example, ask staff members to look at the situation, write down what they observe, and “report” it to the rest of the team. Leave feelings and interpretations aside.

Week Two, focus on the thinking zone. Have each team member use what they learned in the first week and tell the observing portion of something they observed and expand it by adding a story to go with it (what do they think is happening or happened). Let each team member make up and share their own story. Note differences of interpretation.

Examine feelings in Week Three. Using a flip chart or dry erase board, write down all the possible feelings one can experience in a given workday. Using the example scenario, what feelings may be stirred by the interaction.

In Week Four, examine what you want from a situation. Listening is very important here, listening to yourself and to others. When listening to others, remember you will have your turn to respond. Listen for what they really want/wanted from the situation. Give and take feedback.

In Week Five, you decide what you will do. After examining various options tied to the desired outcome, put your plan in action.

For this tool to be effective, it must be built like any habit. It will take time and commitment to make the Awareness Wheel a routine pattern of communicating. As a team, be patient with each other, ask questions for clarification, and listen carefully as you work through the awareness wheel. If a situation seems untenable, take time out to literally walk through the five zones, using a blank Awareness Wheel for a guide. Through this process, you and your team will be able to resolve a miscommunication.

To return to the situation at the beginning of this chapter, imagine this conversation instead.

Doctor to Hygienist:

(Observe) We have great technology here and I notice it’s not being used regularly. Patients leave the office without seeing pictures of their teeth. (Think) I believe you have great talent and I believe that you want the best for your patients and the office. I think you are probably stretched for time. (Feel) I am grateful for the care you currently give the patients. I feel frustrated, however, that we are having this conversation again. I have invested in this technology that is going unused and I get upset when I see patients leaving without the pictures. (Want) What I want is to have every patient have pictures of their teeth and for you to discuss the pictures with them. I know patients have a choice in their care and I want to be known in the community as a technologically advanced dentist. (Do) I am willing to explore options with you on how to make this work.

Hygienist to Doctor:

(Observe) When I am with a patient, I notice a change in your tone of voice and the way you look at me when you ask me about the patient. (Think) I think that you don’t have any confidence in me and that you think I waste time when the patient is in my chair. I also think my pictures aren’t great and I need time for training, but I don’t have time to take good pictures, never mind train to take good pictures. (Feel) I feel sad, mad, and frustrated when that happens and sometimes I fear losing my job. (Want) What I want is the same as you: to be the best, for the patient to get the best, and for the team to win in that relationship. I also want to be better trained on the camera. I want to feel comfortable taking the photos. (Do) I will explore how an assistant could help me and I will look at my schedule to set aside time for training.

Imagine having that type of conversation in your practice! The power of the awareness wheel can not be underestimated. By first communicating clearly with YOURSELF you can walk the awareness wheel and know what you truly want from a conversation with someone and be more truthful not only with yourself, but with the other person. A quality conversation will occur and you will have the satisfaction of understanding others and being understood.