Speaking as a career advancement strategy.

In a survey of 185 physician executives, 75 percent said "listening and speaking skills were important in achieving a managerial position...and communication consumes 90 percent of a manager's workday." [1] Nations Business interviewed managers and found that "when 1,158 newly promoted chairmen, presidents, and vice presidents from a variety of organizations were asked to name the courses that best prepare students for business leadership, courses in communication were named most often--even over courses in finance, accounting, business planning, and marketing." [1]

Most of us assume that because we were born with a mouth and ears we can naturally communicate. It's not so. "Effective communicators are like good athletes: They work at it." [2]

If you're used to getting what you want because of the power of your position, it will take much self-discipline to struggle with communication skills. Being more powerful than another person and throwing your weight around is an acceptable goal in some circumstances. Lawyers intend to operate that way in a courtroom. Don't think, however, that good communication is happening in those situations and that everyone goes away feeling satisfied. Somebody wins and somebody loses. We're striving to create situations where both people feel good about what happened in the exchange.

Good communication skills are worth the work and energy that they demand. "Nothing is more essential to success in any area of your life than the ability to communicate well. Nothing can compare to the joy of communicating love, of being heard and understood completely, of discovering some profound insight from another's mind, or of transmitting your own thoughts to a rapt audience." [3]

What will make people listen to you when you talk?

Pronounce your words clearly. Enunciate. Don't mumble. If you do not speak loudly enough, most people will tune you out and mentally decide you are not worth their time or trouble. They also think you have no power or influence if there is no power in your voice. If English is your second language, you may have to speak louder and slower to be understood. You may think people should struggle to understand you, but I have found they won't, even if they are pretending to listen.

Talking too loudly is as offensive as talking too softly. If good communication is like the rhythmic back and forth motion of a good volley in tennis, talking too loudly is like taking a basketball and repeatedly hitting the other person with it. People usually respond in one of two ways. They are hurt and will try to get away from you as soon as possible. Or they get angry and begin to scream back at you.

Don't talk too quickly or too slowly. If you race through conversations, people miss part of what you say, but they seldom let you know for fear of having you surmise that they are slow thinkers. Conversely, if you have long pauses between words or sentences, people go to sleep, get bored in the middle of the conversation, or think you don't know what you are talking about. Some pauses are good. They serve as breathers to allow thinking time, add emphasis, and show you are confident enough to have a few seconds of silence. Just don't overdo them. Southerners sometimes have to speed up. Northerners sometimes have to slow down. Midwesterners seem to get it about right. Notice that television anchors, who are trained to appeal to the entire country, have a medium but steady pace.

Look at the person to whom you are talking and have the appearance of enjoying the conversation. If you look over the listener's shoulder, he or she wonders what's behind him or her. If you look at the ground, you portray weakness. People want to see your eyes. (Have you noticed how difficult it is to have a serious conversation with someone wearing sunglasses. You think they are hiding something or are afraid.) However, do not stare them down. That is just as disconcerting as never looking at them. We all look away to think or just to give each other a rest. The eyes truly are the window to the soul, and no one wants to be totally exposed, but, as a general guideline, look at the person you are talking to, recognize him or her as an important human being, and let the person see what you are thinking as well as hear it.

Use appropriate body language--relaxed, open. Pacing up and down or holding your arms tight across your chest creates or heightens anxiety. Don't point constantly when you talk or make any strange gesture repeatedly. Look at yourself on videotape to see if you have any odd mannerisms. It is amazing how unaware we can be. I've seen people scratch places repeatedly that should only be touched in private.

Use average size words. If you sling a lot of jargon or large words that most people do not know, you alienate them. As a general rule, people will not speak up and say, "Hey, I don't know what you are talking about." They do not want to appear to be less intelligent than you are. "Many people seem to think it's necessary to use big words, technical terms, and complicated sentences to make themselves sound knowledgeable. In fact, just the opposite is true. Only someone who truly knows his subject can say what he wants to say in clear and simple language. The fastest way to put your listener to sleep is to talk to him in language he doesn't understand." [4]

To show how a beautiful passage can lose its clarity by the addition of typical business jargon, read the original introduction to Moby Dick and then the rewritten version:

Original

"Call me Ishmael. Some years ago--never mind how long precisely--having little or no money in my purse and nothing in particular to interest me on shore, I thought I would sail about a little and see the water part of the world.

Jorgon added

"You may identify me by the nomenclature of Ishmael. At a point in time several years previous to the current temporal zone--the precise number of which is extraneous information--devoid of sufficient monetary resources and lacking physical and/or psychical stimuli within the confines of my sphere of activity on land, I initiated several thought processes and concluded that I would commandeer a vessel of navigation with which to explore the aquatic component of this planet." [5]

Don't talk longer than a couple of minutes (some say 30 seconds) without letting the other person talk. An important part of speaking effectively is not speaking too much. "If most of the time you talk more than you listen, you're probably failing in your communication and probably boring people, too." [6]

Taking turns was a valuable thing to learn in preschool, and we never outgrow the need to do it. As a shy child I didn't always get my turn and I felt sad, left out, angry. Sometimes I'd go away feeling lonely. Other times I'd try to figure out how to get revenge, particularly with my older brother. You do not want people in the organization thinking about how to get even with you.

I've had people say, "Why should I give you a turn if you can't fight to say what you want to say." If you are familiar with Jung's concept of extrovert and introvert, extroverts talk and then figure out what they think, introverts figure out what they think and then talk. Introverts have valuable information if you give them the time to say it.

Extroverts sometimes talk too much. If you go on and on when you talk, people dread being around you. When they have to come to your office for a business conversation, they plan ways to get out before they ever come in. I have recommended to people that they squeeze one hand with the other to remind them of a change they want to make. The mild pain is a signal to the brain not to keep talking.

Wonder describes a cure for a client who talked too much in meetings. [7] He drew on paper an imaginary tongue depressor divided into four parts. He could speak four times in a meeting and then no more. He had a hard time controlling himself at first but finally accomplished his goal. Eventually he didn't need the image of the tongue depressor on paper but carried it in his mind. "Six months later," he said, "this is one of the most valuable changes I've ever made. I've found that I get so much more out of a meeting by listening to others. I'd always felt responsible for rushing in and filling gaps in conversations and responding to a lecturer. Now I don't feel the tension I used to when there was a moment of silence. I'm more apt to see the big picture than before, and I recall the meeting as a whole, rather than just bits and pieces."

Suppose you don't speak up enough. Before you go into a meeting or a conversation, write out what you might say on a particular issue. You will not read it, but if you have focused your thoughts beforehand, you are more willing to risk your ideas. Then set a goal for yourself to speak at least twice during the session. Put a check on the notes in front of you each time you speak. If you have trouble speaking up on a unexpected topic that is being discussed, pretend to take notes about what others are saying, but really write down what you'd like to say. Once you see what you've written and see that it makes good sense, you will be more willing to say it to the group.

Be willing to tell what you feel about a subject as well as what you think. Give a personal example. We are fascinated by each other's stories if they are sincere, authentic, and not meant to show that we are better than another.

Know what you want and be willing to ask for it. Before an important conversation, do some planning. An effective way to ask for what you want is to use any of the following steps that seem appropriate to you. [8] Write out the information beforehand so you will be clearly focused.

Explain your view of the situation. "We are not getting trauma patients to the operating room fast enough."

Tell what you want to happen. "I'd like the surgeons to come in earlier to help with tests and start IVs so we can get the patients upstairs faster."

(Very often, the first two steps are all that are needed. It's amazing how often people do not ask for what they want. If they want co-workers to change behaviours, they will tell friends but not the people who need to know.

Tell what you like or don't like. "We have excellent surgeons in this hospital."

Share your vision of how things could be. "We could be known as a Level 1 trauma unit and the best in town if we have their help."

What if none of these first four steps work?

Find out who has what power. Do you have something the other person wants that you can withhold if he or she does not change? The only way you can force change is if you have some power. If the first four steps do not work, you have no bargaining chips, and you encounter only resistance, it is time to walk away. However, in most situations, you have some power. A number of people can join together and ask for something. Most people want to be thought well of by others, so if a significant number of people are making a request repeatedly, often the change will occur.

Remember also to use a good tone of voice. Sound firm and confident if that's what's called for--soft and conciliatory if that is appropriate. As my mother used to say, "It's not just what you say, it's how you say it." We need to have all styles in our repertoire of skills.

Barbara J. Linney is Director of Career Development, American College of Physician Executives, Tampa, Fla.

Reference

[1] Staley, R., and Staley, C. "Physician Executives and Communication." Physician Executive 15(2):15-7, March-April 1989.

[2] Swets, P. The Art of Talking so That People Will Listen. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1983, p. 9.

[3] Ibid., p. 4.

[4] Frank, O. How to Get Your Point Across in 30 Seconds-or Less. New York, N.Y.: Simon and Schuster, 1986, p. 63.

[5] Kolin, P. Successful Writing at Work. Lexington, Mass.: D.C. Heath and Co., 1986.

[6] Ailes, R., with Kraushar, J. You Are The Message. Homewood, Ill.: Dow Jones-Irwin, 1988, p. 52.

[7] Wonder, J., and Donovan, P. The Flexibility Factor. New York, N.Y.: Ballantine Books, 1989, pp. 216-7.

[8] The first four points are based on material presented by Irwin Rubin, PhD, at the National Institute on Health Care Leadership and Management each year in his course "The Management of Professionals in Organizations."